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 offering 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 ELEMENTS • Structured curriculum + 1. Engagement group process 2. Awareness • Holistic approach 3. Goal Setting • Individualized goals 4. Skills Mastery • Repetition, Reinforcement & 5. Generalization (applying Feedback knowledge to daily life) • 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 Process • Ability to commit to 13-week 1. Information Session group, forgoing other groups 2. Application offered at Krempels Center 3. Group participation vetting • Medical Stability (based on criteria) • Some degree of insight 4. Notify accepted members • Self-regulation (participate 5. Pre-test assessments (starting without a caregiver) where the client is at) during • Receptive and expressive pre-group orientation communication skills 6. Hold sessions 1-12 allowing for group 7. Post-test assessments & interaction 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 7. Social Confidence through 1. Orientation and positive self-talk assessment 2. Skills of a great 8. Practice in the community communicator (outing) 3. Self-assessment and goal- 9. Social Boundaries setting 10. Video taping 4. Starting conversations 11. Video feedback- practice 5. Keeping conversations in the community going and using feedback 12. Conflict resolution 6. Assertiveness and solving 13. Closure and celebration problems
Group Norms Established 1. Will participate by listening to others, providing respectful To provide nurturing feedback to peers and being atmosphere of trust open to receiving with the goal of learning constructive feedback from from each other's others successes and 2. Mindful of allowing and limitations/challenges 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 other 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 Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1985) • Measure global life satisfaction 1 = strongly disagree • Developed by Diener et al. 2 = disagree 3 = slightly disagree • Higher scores = greater life 4 = neither agree nor disagree satisfaction. 5 = slightly agree 6 = agree • Has been used for persons 7 = strongly agree with TBI __ 1. In most ways my life is close to my ideal. __ 2. The conditions of my life are excellent. ➔ No significant change pre and __ 3. I am satisfied with my life. __ 4. So far I have gotten the important post for participants A or B. 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
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