School of Health Professions
Assignment Word Count: 3847
Module Code: OCT 211
OCT 211 Occupational therapy toolbox
The occupational therapy (OT) process guides practitioners through practice, regarded as a highly essential tool, for every practitioner, across all settings and client groups (Duncan, 2012). Therefore, this essay will discuss five elements of OT practice that broadly covers the OT process through a wide range of life stages, conditions, client groups and age ranges and will reflect on professional development and group working. Comment by Tanja Krizaj: Good introduction to guide the reader.
Assessment (542)
Assessments, non-standardised and standardised, are recognised as an important part of the OT process, identifying the strengths and needs of a client (Boyt Schell, 2009). Standardised refers to a tool that is reliable and valid, accountable for a population, whereas non-standardised is an informal way to assess and evaluate, introducing a wider variation in outcome (Polglase and Treseder, 2012).
The Assessment of Motor and Process skills (AMPS) (Fisher, 2005) (see Appendix 1) is commonly used in the assessment of people with learning disabilities (COT, 2010a). It is a standardised assessment of occupational performance that is client centred, a unique tool (Mesa et al., 2014; Knecht-Sabres, 2014). The assessment can help a practitioner to gain insight into a person’s previous engagement, generating objective measures that can be used to implement evidenced based practice (COT, 2010a); enabling the practitioner to adhere to best practice guidelines, creating a clinically safe environment (COT, 2017). Comment by Tanja Krizaj: Would be good to explain in what way it is unique. Comment by Tanja Krizaj: What exactly does it measure?
However, there are limitations with AMPS, it relies on software that can only be assessed by trained therapists (Fisher and Grisworld, 2014), therefore restricting its use. The main deliberation about the assessment is knowing if the person being assessed, understands what is expected of them when performing the task, therefore questioning its validity (COT, 2010a). Parkinson et al. (2014) argue that if skills are so impaired, requiring high levels of support, another assessment tool should be considered. Despite this, studies have demonstrated that it is a reliable and valid tool internationally (Fisher and Bray Jones 2012), across all language and cultural differences (Mesa et al., 2014). The AMPS has the scope to be used with all people from the age of three, regardless of diagnosis or ability (Knecht-Sabres, 2014; Fisher and Bray Jones, 2012), providing an evidence base for practitioners when using clinical reasoning, supporting professional judgement (Mesa et al., 2014; Merritt, 2010). Comment by Tanja Krizaj: This contradicts your previous argument about AMPS not being appropriate with clients having issues with understanding what is expected of them.
A home assessment is an example of a non-standardised way of gaining insight to the client’s needs and modifications within the home (see Appendix 2), which is routinely performed with older adults, in a physical setting (Polglase and Treseder, 2012; Atwal et al. 2008). Similarly, to AMPS, a home assessment can assess occupational performance, helping to identify levels of engagement and independence in a person (Bridge, 2010). A client centred approach to the assessment, finds it to be effective in falls preventions (NICE, 2013a), as the assessment underpins theoretical frameworks that focus on the impact that the environment has on function (Duncan, 2012; Bowman and Mogensen, 2010). That aside, there is still a poor evidence base for this non-standardised assessment (Bridge, 2010), meaning practitioners will need to draw more on professional experience when conducting and evaluating the assessment to support its effectiveness (Duncan, 2012). Comment by Tanja Krizaj: It depends what home assessment focuses on – is it the environment or motor and process skills?
Home assessments can facilitate a successful, safe and timely discharge from hospital to home (COT, 2015a; Atwal et al., 2008), helping work towards reducing hospital admissions, saving money (COT, 2016a; COT, 2015b; NICE, 2013a). However, it is important to consider the ethical implications when conducting this assessment as an individual may have mental capacity to make decisions but lack insight into the problems with their current living conditions (Cotterill, 2014). This, therefore, could impact on the choice and safety of interventions for the patient, highlighting limitations with the assessment, inferring on practice (COT, 2017).
Planning interventions (510)
Once the initial assessments have been completed, the intervention planning can begin (Duncan, 2012). Planning interventions is a process that organises information linked to a client’s occupational difficultly (McCullough, 2014), outlining strengths and needs, using this information to determine and negotiate aims and objectives (Park, 2009). It is important, as it is essential in contemporary healthcare (Parkinson et al., 2011), as accurate documentation is demanded by healthcare legislation and policy (COT, 2010c; Armstrong, 2008). Comment by Tanja Krizaj: Occupational challenges
From a commissioning perspective, practitioners need to be skilled in areas of planning to ensure services provided are effective, person centred and occupational focused (COT, 2017; HCPC, 2016). By following guidelines practitioners can work together with the client to identify their aims and objectives, as collaborative client centred, occupation-focused planning is at the heart of OT practice (McCullough, 2014). Armstrong (2008) discusses how key client centred intervention planning is, enabling opportunities for collaboration and communication but also gives clear focus for the multi-disciplinary team (MDT); providing tangible evidence of client centred occupational intervention for health care professionals involved with the client’s care. Comment by Tanja Krizaj: Not all health professionals would focus on the occupation-focused intervention.
Aims and objectives are important, forming a platform and giving basic direction for intervention planning; giving precise statements of action that help to guide the client through the intervention phase, working to achieve improved occupational outcomes (Polglase and Treseder, 2012). Subsequently, clients that set aims and objectives achieve better outcomes and gives opportunity for the client to experience a key benefit of OT, giving support in improving health and wellbeing through engagement in meaningful occupations (Wilcock and Hocking, 2015; Park, 2009). By making the objectives smart, measurable, achievable, realistic and timely (SMART) it can help maintain direction through the OT process and give more opportunity to a definite discharge and review for the client (Bowman and Mogensen, 2010), facilitating effective practice (COT, 2017). Comment by Tanja Krizaj: Very good discussion. Further consideration of client-centred approach would have enhanced this section.
Throughout the three stages of intervention planning practitioners should look to be guided by models of practice (Kielhofner, 2008; Polatajko et al., 2007; Iwama, 2006), as each provide rigorous frameworks, assisting therapists when planning strategies, to account for all inter-related constructs (Bowman and Mogensen, 2010). However, without this consideration it may lead to inconsistent working (Polglase and Treseder (2012). It is also important to consider frames of reference and approaches as they help the practitioner to work through the plan (Supyk-Mellson and McKenna, 2010), achieved through clinical reasoning, helping to inform future intervention choices (Morgan and Long, 2012). Therefore, ensuring the highest standards of practice are met (COT, 2017). However, it is argued by Polglase and Treseder (2012) and Duncan (2012a) that poor or no planning can lead to ineffective interventions, it can limit progress, areas can be omitted and the client is less involved. Consequently, hindering effective practice, as if a therapist is absent others can be unaware of how to work with the client (Park, 2009). Comment by Tanja Krizaj: Not sure what you mean here.
Overall, intervention planning helps to improve communication between the interdisciplinary team and client, assist in creating stronger interdisciplinary working relationships, encourages motivation by meeting the unique needs of the client but also ensures conformity to health policy, assisting in meeting legislative requirements.
Interventions (1133)
Engagement in everyday occupations is encouraged through OT interventions (Law and McColl, 2010). Activities of daily living (ADLs) and yoga are two different types of occupations for intervention. The difference being that yoga can be regarded as a leisure occupation, used in a 1:1 intervention and ADLs are predominantly self-care and productivity occupations, and can be used in a group intervention. However, when engaging in any occupation, contextual factors need to be considered, as occupational performance is entrenched within physical and social environments (Blesedell et al., 2014). For example, yoga promotes awareness of self and so it is crucial to be in an environment that enables a mind-set conducive for change (Hoyez, 2007). With no consideration to this, it can dampen performance and engagement (Loukas, 2014). Therefore, attention should be deeply rooted around contextual factors in the planning stage (Bowman and Mogensen, 2010). Comment by Tanja Krizaj: Not sure whether you are referring to these occupations in general OR are you referring to your chosen interventions for the purpose of this assignment.
Both interventions must be formed upon and influenced by theoretical frameworks and evidence based, guided by approaches, as this gives direction and focus to the interventions, leading to more clinically effective outcomes and safe practice (COT, 2017). In addition to this, clients should have choice and full participation in the decision-making process, to ensure interventions are ethically viable (Duncan, 2009). Comment by Tanja Krizaj: Would be good to explain which client-groups you are referring to in each of the interventions.
The fundamental nature of occupations, such as, yoga and ADLs, are used therapeutically throughout practice (Immink, 2014; Scaffa, 2014). Each underpinning the philosophy of the profession, as the current paradigm drives the profession to work holistically, highlighting and identifying relationships between occupation and wellbeing (Wilcock and Hocking, 2015). Without this consideration, it can impact on the effectiveness of the intervention (Gillen, 2014).
An ADLs group intervention can be beneficial for children with developmental coordination disorder (DCD) (Zwicker et al., 2015; Dunford, 2011). Children with DCD have been shown to have problems with dressing, manipulating utensils when eating and sequencing (Armstrong, 2012). Dunford (2011) identified the effectiveness of this intervention for children with DCD, expressing how improved skills and performance can be achieved through working with groups of children to achieve individual aims. Although a group intervention is harder to tailor to the individual with DCD, due to the differing developmental stages of each child, it can be more beneficial as there are peer group benefits, more resource efficient and cost effective than 1:1 interventions (Zwicker et al., 2015; Martini, Mandich, and Green, 2014). However, this group may be challenging to replicate in different settings due to its intense nature, limiting its transferability (Armstrong, 2012). Despite this criticism, the intervention exemplifies how occupational focused group interventions can enhance an individual’s self-esteem and wellbeing, while developing skills (Craig and Finlay, 2010), therefore, promoting positive change for group participants (Scaffa, 2014). Comment by Tanja Krizaj: Although engagement in ADL is important for this particular client group, it is not clear how to carry out this intervention in a group.
Appropriate approaches to the intervention would be task specific and cognitive orientation to occupational performance (CO-OP) (COT, 2015c; Dunford, 2011). A CO-OP approach enables mediation and guided discovery, helping to teach organisational strategies and sequencing (Case-Smith et al., 2010). Therefore, helping a child with DCD, to use these strategies in numerous settings and to be able to transfer skills to other tasks (Sugden, 2007). Using a combination of approaches improves performance and enhances problem-solving skills of a child in relation to the child’s ability to do everyday activities; emphasising the relevance of approach to intervention in promoting independence and encouraging meaningful outcomes (COT, 2015c; Blank et al., 2012).
The group can be modified by adapting and grading the activities, for example, the button and button holes on children’s clothing, changing the demand of the activity from easy to hard, depending on the child’s abilities (Dunford, 2011). Chambers and Sugden (2016) argue how effective this approach to intervention modification is, facilitating increased active participation, positively influencing health and wellbeing. Comment by Tanja Krizaj: It would be helpful to provide further evidence about the benefit of self-care occupations for people’s health and well-being.
While there is an increasing evidence base highlighting the strengths of group interventions, structural issues with group interventions have been acknowledged (Scaffa, 2014). Camden, Tétreault and Swaine (2011) identified issues with the ability to develop expertise for each specific group when there is staff turnover but also around the referral process, groups are prioritized compared with individual interventions, questioning appropriateness. Hence, sometimes, on an individual basis, clients may be more efficiently handled.
Conversely, when considering single interventions, each intervention is built around just one client, enabling therapeutic relationships to be built, allowing the client to be the focal point throughout the OT process and intervention (O’Brien, 2014). Thus, working within this frame echoes OT philosophy and best practice (Parker, 2012). Comment by Tanja Krizaj: Valid point.
Yoga practice is regarded as an effective individual intervention in stroke rehabilitation; vitally important in addressing a client’s mental and physical health (Immink, 2014). Without doing so, it can decrease independence in activities of daily living and mobility; affecting recovery, quality of life and wellbeing (Mishra et al., 2012). A randomized control trial of a 10-week yoga intervention identified significant improvement in perceived motor function, decreased state anxiety and quality of life for each client (Immink, 2014). However, variations in yoga practice make it difficult to evaluate its efficacy and so therefore the intervention should be designed to meet differing characteristics of each client (Lazaridou, Philbrook, and Tzika, 2013). Therefore, intervention modification should look to adapt and grade yoga poses to meet the changing needs of the clients, suiting the level of impairment, function and mobility (Schmid et al., 2014). Comment by Tanja Krizaj: Excellent evidence.
Although it may not be a meaningful activity for every client in stroke rehabilitation, yoga is a novel modality that practitioners can use to complement rehabilitation treatments in addressing the physical and psychological well-being of stroke patients; supporting occupational performance (Garrett, Immink, and Hillier, 2011). Consequently, having positive effects on psychosocial functioning including anxiety, self-efficacy and depression (Immink, 2014), supporting the rationale for using yoga in rehabilitation programmes.
Through biomechanical, neurodevelopmental and psychological-emotional approaches the physical, affective and social components of the client can be addressed (Polglase and Treseder, 2012). For example, a biomechanical approach can focus rehabilitation of functional mobility through yoga, encouraging improved perceived range of motion, muscle strengthening, motor function and balance. Although a biomechanical approach takes a more traditional bottom up approach, it helps the client to understand their body and disability, overcoming barriers that are limiting participation in meaningful occupations (Immink, 2014). Clients have a potential to appreciate and re-learn the sensations their bodies are experiencing, building confidence, enhancing wellbeing and occupational performance (Woodyard, 2011).
Both interventions, although achieved through different types of occupations, are sufficient in addressing the occupational disruption being experience by the client. This highlights how important enhancing self-esteem and wellbeing can be in improving occupational performance and to the success of an intervention. However, a practitioner must anticipate the need of support and vulnerability of a client when choosing the most appropriate intervention, as a group environment may be too intimidating (Griffiths & Corr, 2007). Overall, interventions must look to enhance motivation, self-esteem, health and wellbeing, using evaluation tools and methods to measure effectiveness. Comment by Tanja Krizaj: You have chosen appropriate interventions and provided some excellent evidence to support this. Further exploration of the value of self-care as an occupational area would have enhanced this.
Evaluation (1040)
Evaluation is a core component of the OT process, interpreting and appraising obtained information of a client’s occupational performance (Breckenridge and Jones, 2015). Through consistent re-evaluation, the worth of interventions can be judged (Polglase and Treseder, 2012). Occupational therapists must adhere to guidelines, as the use of appropriate evaluation and outcome measures are specified within the professional standards, identifying the importance of evaluating outcomes in practice (COT, 2017; HCPC, 2016). The difference being that outcome measures are measureable, producing quantifiable data that can contribute to evidence based practice, serving to improve care (Polglase and Treseder, 2012). However, any form of evaluation enables revision of any necessary plans in conjunction with the client, monitoring the effectiveness of each intervention but also contributing to service development, audit and research (COT, 2016b).
These processes can be implemented in a group intervention that addresses wellbeing in older adults with dementia (Clark et al., 2011). Through interacting with others with similar difficulties, the intervention group can encourage a sense of belonging, providing positive social contact, encouraged sense of wellbeing, giving opportunity to engage in meaningful activities, improving occupational performance and overall quality of life (Woodbridge, et al., 2016; Teitelman, Raber, and Watts, 2010; Hampson, 2009). When evaluating the group for people with dementia, it would be appropriate to measure quality of life, as this is recommended by national guidance (see Appendix 3), stating quality of life for people with long term conditions should be enhanced to help maintain independence (DOH, 2014; NICE/SCIE, 2007). Therefore, giving the rationale for intervention, providing a format to establish whether the intervention has made an improved difference in occupational performance and to the client’s life.
In addition to following national recommendations, practitioners should refer to relevant legislation, Mental Health Act (2007) and the Mental Capacity Act (2007) for dementia care but it would also be appropriate to refer to Care Act (2014) and safeguarding policy (NHS England, 2015) to capture safe, professional and effective practice (COT, 2017). For example, section 3 of the Mental Health Act (2007) states that with a degenerative illness such as dementia, reassessment throughout therapy is crucial, providing relevance to outcome measures and evaluation.
As with assessment, evaluation methods can be standardised and non-standardised (Polglase and Treseder, 2012). A form of non-standardised evaluation, to evaluate the individuals in the wellbeing group, is the Mayer’s Lifestyle Questionnaire (MLQ) (Mayers, 2003) (see Appendix 4). As a person-centred tool, the questionnaire, identifies the client’s perceptions of their own occupational performance and the impact that has on quality of life (Mayers, 2003); getting the client to complete the questionnaire before and after intervention to establish any change. Therefore, an appropriate tool to be able to identify areas for improving mental and physical well-being, occupational performance and cognitive functioning in older people. However, it is not specific to dementia and the client may require assistance when completing the form (Mayer, 1998). With this consideration, following up and finding out the reasons for the client’s responses will be important, so an accurate evaluation can be made (Bullock, 2014). It has been argued by Laver-Fawcett (2007) that the MLQ form is standardised, however, there is a need for more evidence to clarify the MLQ’s reliability and validity for this population and so therefore cannot be recognised as standardised within OT practice. Nonetheless, even though the MLQ is not an OT specific form of evaluation, Laver-Fawcett (2007) discusses how the Mayer’s lifestyle questionnaire can be successfully used in evaluating quality of life for people with dementia; helping work towards national recommendations in dementia care (DOH, 2014; NICE, 2013b; NICE/SCIE, 2007). Comment by Tanja Krizaj: Would be good to consider potential challenges considering the client group.
Conversely, The Model of Human Occupational Screening Tool (MOHOST) (Parkinson, Forsyth, & Kielhofner, 2006) (see Appendix 5), is recognised as an occupation-focused standardised outcome measure, specific to OT (Bullock, 2014; Lee et al., 2011). A repeatable, valid and reliable tool that considers motivation for occupation, communication, pattern of occupation, motor skills, process and environment, stipulating an overview of the client's occupational functioning (Pan et al., 2011). This enables practitioners to select which activities can be assessed, within the wellbeing group, therefore helping to tailor evaluation that considers occupational performance within the person’s environment and routine, contributing to improving wellbeing (Lee and West, 2014).
However, a limitation of MOHOST, is that it is not specific to dementia and so further scoring may be required beyond R (Restricts occupational performance) when administering the tool for people with dementia (Parkinson, Forsyth, & Kielhofner, 2006). In addition to this, with dementia clients, adapted language may need to be used within the assessment (Kielhofner, et al., 2009), questioning the tool’s reliability and validity (Bullock, 2014). To ensure the tool is used in a standardised way it may only be applicable for patients with mild to moderate dementia (Swinson et al., 2016), again limiting its use in practice for this specific client group. However, with minimal training, practitioners can use MOHOST for clients with dementia, as a standardised outcome measure, in an interchangeable and consistent way to gauge change in occupational performance and participation (Kramer et al., 2009). Comment by Tanja Krizaj: How would that influence the outcome measurement considering the tool is standardised?
When comparing them both, each form of evaluation can be used to identify the client’s perceptions of their abilities and health status; enabling a consistent and comprehensive assessment of quality of life and functional ability, an important detail in evaluation (DOH, 2014). Practitioners are obligated to contribute to the evidence base related to the efficiency of OT interventions; when using standardised outcome measures, each has ethical responsibility to ensure knowledge and skills are up to date, impacting positively on service delivery (COT, 2015d; Hocking, 2014).
Although non-standardised forms of evaluation can be used effectively, practitioners who chose to use them must consider limitations related to accuracy and reliability (Laver-Fawcett 2007), as they are no longer acceptable to service commissioners and funders (COT, 2013); potentially impacting on professional credibility, if practitioners continue to use them (COT, 2013). Without evaluation, the values of assessment and intervention diminish as no objective measures are being generated (Bullock, 2014). Therefore, in practice, the selection of appropriate outcome measures and the responsiveness of the selected outcome measure to detect the amount of anticipated change are critical; reflecting on the effectiveness of the interventions and measures used if this is not achieved (COT, 2017; COT, 2015e; COT, 2010b).
Group processes (548)
In becoming an autonomous and professional practitioner it is essential to work collaboratively within a MDT, working towards national guidelines, providing the most suitable and efficient service to the user (COT, 2017). In education, problem based learning (PBL) groups are used to mirror MDT working, preparing students for professional practice, allowing each student to recognise their own learning styles and roles to identify strengths and weaknesses, uncovered when working though group processes (Galle and Marshman, 2010).
When recently participating in a PBL group, I have learnt to effectively communicate with my peers to build upon our evidence base and understanding the workings of the OT process; essential key skills needed in becoming an autonomous practitioner. Reflecting on these sessions (see Appendix 6), I have identified when working within a group, I am an active listener, encapsulating information from group members, synthesising this information for the group, enabling action plans to be formulated. Tuckman’s group development theory states that when a group is in the performing stage, effectively working together creates a supportive emotional environment, encouraging growth and therapeutic change (Cole, 2012). I can relate this to how I felt I performed within the group, as when the group was developing, in the forming stage, I was not able to speak with as much confidence. However, as the group developed and became cohesive, the supportive environment helped my confidence to grow. Comment by Tanja Krizaj: A very good reflective account.
Prior to PBL working, using the Belbin roles of self-perception questionnaire (see Appendix 7), I identified myself as team worker; a person who is co-operative, diplomatic and averts friction (Belbin, 2010). I felt I actively played this role when nominating myself for presenting. I had to work outside of my comfort zone, to contribute to effective team working, being a good team player. I feel it is important to have team worker roles within a team to reach an established, performing group.
Understanding these theories, will help to develop my self-awareness in group working, I will be able to identify what role I am playing in a group but also what other roles, members of the group are taking; identifying the stages the group is going through as it develops, provide useful foundations for practice as a professional, enhancing my confidence.
Going forward, I can identify actions I need to take to enhance my professional development. The PBL sessions opened my eyes to what it will be like to work as a part of a MDT in professional practice, putting forward problem areas and discussing these with other professionals, using an evidence base to find solutions. Therefore, it will be important to always actively listen when working within an MDT, taking on board what other professionals say, using this acquired knowledge to help me understand every aspect of a client and the care they are receiving. By participating fully in MDT sessions, it will encourage effective communication between the team and the service of which I may be working in. As the cohesion of a MDT improves so will my confidence and I will be able to generate discussion around my own gaps in knowledge. I will need to make sure I always ask questions and participate in discussion, even if I do not feel confident to do so, to work as a safe autonomous practitioner.
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Appendix 1: AMPS
Appendix 3: NHS Outcomes Framework 2015/16 (at a glance)
Appendix 4: Mayer’s lifestyle questionnaire
Appendix 5: Model of Human Occupational Screening Tool (MOHOST)
Appendix 6: Reflective accounts
What happened?
· Introductions were made by everyone in the group
· We formulated some ground rules for PBL working
· Decided to set up a Facebook group to make communication easier and to make a time table for chair and scribe
· Trigger was revealed
· Allocation of areas to research for following session
What you did and how this was received by the group
· I was an active member of the group, listening to ideas for discussion, participating when I felt I could
· I felt what I said was always positive received and discussed with the group.
What other people did and how this was received by the group, and by you
· One group member took role of scribe and one as chair, writing up and recording the session well.
· Other members put themselves forward for setting up the Facebook group and to compose the scribe/chair rota
· There was participation from most group member’s around the trigger but not all, this could maybe to do with working within a new group and not everyone had the confidence to speak up.
How you felt about all of this
I was a little nervous at first but as soon as everyone started to talk I felt my confidence grow and I could fully participate in the discussion. I felt we have a good PBL as most people within the group have already previous worked with and I am looking forward to getting to know others in the group that I haven’t worked with yet.
What issues or questions did it raise for you?
I am aware that I don’t initial have much confidence in what I’m saying initially, but after reading around the topic I always feel I can confidently speak in a group scenario.
What have you learnt from this?
Joining/forming a new group is hard as you’re not too sure what to expect, but if some group rules are established it gives everyone a platform to work from, something to tackle the emerging new dynamics of this group compared to the last PBL group I was in.
What are your emerging strengths/areas for development?
· To have confidence in myself to speak up, and to trust what I’m saying is worthy enough to contribute to the group.
· To remain and active listener as I feel it helps me process and understand what is going on.
How might you adapt your behaviour in the next session?
· To continue listening to what others must contribute to the group
· To push myself to speak more within the group sessions and take advantage of the times I must scribe and chair to build by confidence
PBL group work reflection - week 3
What happened?
Over the last few weeks’ our group has worked together to gather research and has gained a very good evidence base to build our presentation around. Presentation a was delivered well, every member of the group got to speak, some constructive feedback was well received. However due to limited rehearsal time, we did not manage to complete the presentation within the allocated time.
What you did and how this was received by the group?
I researched around various topical areas, such as, assessments and outcome measures, feeding this back to the group over the following sessions. I worked with the group to help design and piece together the presentation, completing all tasks allocated to me. I felt that I had an active role within the group. Fully participating in every session held and by doing so I feel had a positive impact on the dynamics of the group and this behaviour was well received by the group– encouraging the group to function well together, moving through the different processes of group forming.
What other people did and how this was received by the group, and by you.
Others in the group contributed well by researching other areas we had discussed the evidenced gathered could be well placed within the presentation, meeting task objectives to help piece it all together. Although all group members contributed to the work we had to do, some were a little more vocal then others but this could be to do with the stage that our group were in – possibly forming/storming.
How you felt about all of this
The section I had to work on and put together was on assessments, the focus of the presentation for this trigger. When rehearsing the presentation, the assessment bit ended up being the shortest and so I was worried that it would not be enough for the objectives we had to meet. However, we still received positive feedback overall on all aspects of the presentation.
What issues or questions did it raise for you?
That for the quieter members of the group it will be important hat that they are always fully included into the group when some of the more vocal members tend to take control. Also, that we need to concentrate on perfecting timings when delivering presentations.
What have you learnt from this?
That the group is still in the forming/storming stage of the group work process and will hopefully improve as we work more together throughout our PBL sessions.
What are your emerging strengths/areas for development?
I feel after the last few weeks I work well with the majority and that we can all work effectively together to achieve. It is apparent that some members of the group have formed closer relationships with members far quicker than I have, forming sub groups and so I feel that the group has not yet become cohesive.
How might you adapt your behaviour in the next session?
I feel I need to be more open to forming new relationships with other members of the group and to help encourage the quitter members of the group to speak out a little more, promoting a space where they feel comfortable to be able to do this.
PBL group work reflection – end of sessions/evaluation
What happened?
Participated in numerous PL sessions in which designed and developed a new group protocol; prepared and delivered the group to our peeps to mirror professional practice
What you did and how this was received by the group?
I helped to contribute contributed ideas, structure for group sessions, 
and researched to add to our evidence base, nominating myself to present when needed. Well received by the group as not everyone wanted to present.
What other people did and how this was received by the group, and by you.
One member when giving out prizes for group, gave winners and losers...winners for winning and losers for taking part. Can use this in my own practice by ensuring to recognise all achievements made by everyone in the group creating support environments inclusive of everyone's achievement 
How you felt about all of this
· Worked well as a group throughout planning setting up and presenting and debrief supportive giving good feedback to each other. Flexible teamwork very positive even after difficult group 
· Good clear presentation style 
· When we got interrupted for making too much noise, videos not running smoothly funny though 
· As the group developed and became cohesive, the supportive environment helped my confidence to grow.
What issues or questions did it raise for you?
Consider clients writing skills in groups, asking people to write things down might be challenging for some. Need to think of different ways to get feedback 
What have you learnt from this?
· Some group members didn't get into role so made it hard to deliver the group-not engaging enough
· Time constraints with group sessions couldn't effectively deliver group as just showing snippets 
· Run through to tidy up things that didn't work-work out how to use YouTube links
· I have identified when working within a group, I am an active listener, encapsulating information from group members, synthesising this information for the group, enabling action plans to be formulated.
· I feel it is important to have team worker roles within a team to reach an established, performing group.
What are your emerging strengths/areas for development?
· I like working as part of a team, active listener, know my limits. Can recognise when lacking knowledge/insight 
· I identified myself as team worker; a person who is co-operative, diplomatic and averts friction
How might you adapt your behaviour in the next session?
Staying positive helps to keep group together
To always push myself and actively participate to successfully work together as a part of a team.
Appendix 7: Belbin’s self-perception questionnaire
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