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HH2800 – Enabling Health and Wellbeing
through Occupation
Element 1
A reflective portfolio considering
Occupational Therapy work with

three life stages.
(Promoting and assessing critical thinking 2012)
Index
Introduction Page 3
Section 1 : Preparatory Reflection Page 4
Section 2: Reflections in action Page 7
Older Adults Page 7
Adulthood Page 11
Children and Yong People Page 15
Section 3: Retrospective Reflection Page 19
References Page 22
Appendix 1 – Group Protocol – Older Adults Page 24
Appendix 2 – Group Protocol - Adulthood Page 29

Appendix 3 – Group Protocol – Children and
Young People
Page 33
Introduction
The following portfolio has three main sections in which I will reflect upon my practice as
an Occupational Therapy student. I will write five different reflective pieces throughout the
essay and under these headings related to the group-work undertaken during this module.
The first section is a preparatory reflection which was undertaken before the module
started and which accounts for the views I have about myself as a learner and to the
extent I would participate and engage in this particular module. This will also reflect the
skills and strategies I could bring to the group-work.
The second section - reflections in action - reflects on three separate student led topics.
Each topic pertains to a different life stage as outlined in the module (older adults;
adulthood; adolescents and children). Within each life stage reflection, a particular model
of reflection was used to enhance the quality of reflection and to give guidance to the
reflective exercise itself.
The third section of this reflective portfolio accounts for a retrospective reflection of myself

as a learner during the entire module, the learning outcomes and the recommendations for
improving my professional conduct.
Section 1 : Preparatory Reflection
Working in groups is paramount to Occupational Therapy as it is one of the delivery
methods used by professionals to engage clients (Finlay 2001). As a student I’m looking
forward to enhancing my group-work skills and building my current knowledge regarding
group theory. I hope to become aware of my learning needs when placed in the position of
a professional who is running groups as this module requires (Cole 2005). For this
reflective piece, I will focus on my current knowledge and skills regarding group-work, what
my expectations are and what concerns I have to undertake this module.
I’m aware of differing theories for group-work, such as Finlay (2001) and Cole (2005) and
their respective works regarding groups. My professional life as an Occupational Therapist
Assistant in a mental health setting, has given me the opportunity to observe group-work
theories in action. I have experienced such practice groups being facilitated by senior
Occupational Therapists staff from whom I have learned a great deal and I can see why
certain group activities conform or fit in with the differing theories.
Since attending the Professional Development module undertaken in level one of BSc
(Hons) Occupational Therapy course and being allowed to facilitate a group session and
having been provided with feedback from the seminar leader, I believed I have enhanced
my theoretical knowledge.

Cooking, gardening, art or photography are subjects that I’m comfortable with and feel
safe in exploring further during this module. I’m eager to design and create appropriate
sessions for each of the life stages and I believe that this will help me experience different
group-work perspectives as suggested by Cole (2005) in Group Dynamics in Occupational
Therapy.
Before undertaking this particular module, my concerns related to the way in which the
sessions were going to be facilitated and the kind of strategies used that would help me
remain focused throughout the session. Accordingly, Johnson and Johnson (2000) states
that it is usual and normal for new group members to be concerned about what is
expected of them and the nature of the group’s goals. My concern was that If some of the
activities involve participants having to be intimate, I would find this type of engagement
uncomfortable.
Having a safe audience to analyse, critique and point out my strengths and limitations to
after running a group, will be an effective way to understand my group skills and help
evaluate how I can link the theory into practice (Cole 2005). This hopefully will provide me
with a clear understanding of the areas I need to develop or improve in order to become a
better group facilitator.
In conclusion, I believe that this module will provide me with an insight into my skills as a
facilitator/group leader and will give me the opportunity to share my findings with others.
Self-awareness will help me to critique and develop evaluative skills in order to deliver the

best care to my clients. Understanding the group dynamics will change my understanding
as to the importance of group work in the context of a therapeutic activity and to the
profession of Occupational Therapy.
Section 2: Reflections in action

Older Adults
During this life stage the critical incident that occurred was the structure of two group
session having to collaborate. The incident will be looked at in more depth throughout this
essay to provide scope for my reflection.
The model I will be using for this particular reflection is Boud and Walker (Alsop and Ryan
1996). It focuses the exercise of reflection on three different stages; “before”, “during” and
“after” the activity. The following diagram of the Model intends to provide the perspectives
taken during this exercise, such as, “preparation”, “experience” and “reflective processes”.
Fig. 1 – Boud and Walker reflective model (CEBE 2012)
Preparation stage
Before the activity took place our group assembled to discuss and explore options and
strategies that we would use for our cooking session. Group roles such as
leader/facilitator, participant and observer were allocated.
The leader delegated the initial strategy for our reference reading, which included
materials that could be used for the elderly group who had impairment such as stroke. The
session would focus on participants baking scones using adaptive equipment and at the
end of the cooking session, the group would come together to reminisce and eat the
scones (see appendix 1).

COPAM (Creek and Bullock 2008) was the main theory used to equip us with tools to
centralise the activity upon our selected age group. Erikson life stage’s theory was also
used (Gross 2005). Integrity verses despair as the final life stage of this theory was taken
into account when organizing the structure of our activity. To provide directions to our
structure when designing the session the team leader allocated different tasks to each of
the group members, for example researching the informing theory and rational (Cole
2005).
Experience Stage
Our group was the second group presenting a cooking session and the room was
prepared after the first group had finished. The critical incident that occurred involved the
first group incorporating part of their cooking session into ours.
My group discussed this issue and we decided it was going to be more appropriate if we
allowed the first group an allocated amount of time to dish out their food before we ended
our cooking session. We informed our seminar leader about this incident and our change
of plan and we were advised to inform participants about the changes. The participants
stated that they didn’t mind adapting to these alterations in our cooking session.
Reflective Processes Stage
The change to our programme made our group feel uncomfortable and gave our team
leader a stressful situation to manage. This was because we wanted to facilitate the
session in a way that would not compromise the participants’ performance, participation
and well-being as this change could impact on the way that our group would facilitate the

session (Park 2010). However, informing the participants about the changes prevented
any confusing and/or conflicting situations (Cole 2005).
Involving participants into the decision resulted of a “group decision making” momentum.
Group decision making, uses the resources of the group members, thus, allowing
participants to control the outcomes and to be more involved in the group directions
(Johnson and Johnson 2000).
As a group we met the day after and discussed what could have been done differently
during our activity. We concluded that the two groups presenting on that day should have
spoken with each other to find out what each group was doing. This would have avoided
the stressful situation that our group was subjected to.
In summary, this reflective piece, has called my attention for the need to have a plan “B”
prior to delivering a session. I have learnt that it is important to assume changes in
structure and to inform participants about it (Johnson and Johnson 2000).

Adulthood
For this life stage, I was appointed as group leader and the area of learning that I will be
reflecting on is the “session’s aims” and how to effectively deliver them. One of our group
members was not present for this session which impacted on how we achieved the overall
aim.
Fish, Twinn and Purr (Alsop and Ryan 1996) model will be used for this reflective piece.
This model has 4 different strands of reflection that allowed me to look at the area of
learning that was chosen for this life stage. The 4 strands of this model are: “factual”;
“substratum”; “connective” and “retrospective”.
Factual Strand
The session was designed for adults in an acute mental health unit which is part of an
eight week educational course. The session’s aims were related to work and vocation as

demonstrated by Davis and Rinaldi (2004) research; such research provided our group
with the main arguments to choose the aims for our sessions.
Before the session started, our group were informed that one of the facilitators was not
attending due to ill health. The ice breaker needed to be changed and the facilitation to
one of the sub-groups were compromised. As the group leader, I took upon both roles of
leader and sub-group co-facilitator to carry on the functions of the missing co-facilitator
and carried out the changes to the group protocol (see appendix 2).
Overall the session ran smoothly despite the absence of one of the co-facilitators; the ice
breaker was a success according to participants’ feedback. The main activity was related
to Curriculum Vitae writing skills and dress code and participants were observed using a
range of communication skills that enhanced the quality of engagement levels within our
session (Hagedorn 2000).
As we were forced to change the session, the aims and the way the session was delivered
also changed. Participants were only allowed to discuss in the bigger group the dress code
(main activity), instead of exploring it in the sub-groups as planned. Finley (2001) argues
that working in sub-groups is a way to engage participants in further activities and to
maintain participants’ engagement at optimised levels. This change to the original plan put
me under much stress.
Substratum Strand

The fact that one of our group members did not attend the session impacted on our group
dynamics. However, this was overcome by the rest of the facilitators’ actions as they
improvised and delivered a session in a way that the participants would not feel this
impact.
As I was divided in the roles of leader and participant, I became concerned about how to
manage my feelings as facilitator. It was important for me to become aware of my feelings
and emotions when attending to the group’s needs. Accordingly Johnson and Johnson
(2000) states that is important to manage feelings and emotions as this will give facilitators
the notion of a session flowing as “feelings are great sources of information about what is
happening within the group and what sorts of problems are occurring in the relationships
among members” (p. 532).
Connective Strand
Reflecting upon learning for this session has given me the insight how to prepare and
organise group-work in the future, paying special attention to leadership roles and the
reallocation of roles within the sessions’ dynamics have become clear to me (Finlay 2001).
The fact that one of the co-facilitators was not present to deliver the session, made me
focus more on my role as leader and session delivery trying to comply with the initial aims.
This reflection opened my understanding to the way I behave in front of a group as to
maintain the client centred approach (Cole 2008).

Retrospective Strand
Looking at the entire event and the process as a whole I can see that as a leader I was
able to shift from the initial aims to aims that suited the participants within the context of
that day. This shifting of aims and session structure was completely improvised under an
enormous amount of stress. This made me reflect that I need to develop sensitivity
towards how participants involved in the activity felt and the way they viewed it as a whole
(Johnson and Johnson 2000). I should gain the habit of considering a range of different
perspectives during my practice as advised by Finlay (2001). Furthermore, looking at the
fact that I was feeling stressed when running the session could have made participants
feel uneasy with me.
According to participants, the session was a success and they felt that they had attended a
“real group”. Maybe my over confidence to dissimulate my stress and tension made
participants engage promptly within the session and its tasks. Probably, my peculiar style
of delivering the session where I created empathy with others may have created a flow in
the session.
In conclusion I have learnt that it is important to gain knowledge of how to deliver a
session as to provide flow and be more flexible towards the delivery and elaborate upon a
style that is more fluid and less concerned about the structure. This experience has helped
me to consider different approaches when things don’t go according to plan or when one
element is missing.

Children and Young People
As used previously in the adult reflection, the model for this reflective piece, where
students were working with children, Fish, Twinn and Purr (Alsop and Ryan 1996) will be
used. For this particular session, I was one of the participants/observers and my role was
to be one of the sub-groups facilitators and to supervise the work that was done.
Factual Strand
The session was designed for children aged between 9 and 11 years old and of mixed
ethnic and religious backgrounds (see appendix 3). The client group was considered to be
a “healthy population” which means there was an absence of any significant disabling
medical or cognitive condition that could affect their ability to consent to and participate in
this activity.
The client group were pupils attending a particular primary school in a North East London
deprived area that has seen a rise in crime levels, poverty and unemployment. Participants
were reminded beforehand that this was an exercise done with “students” and that the
circumstances would be different were if to be done with real participants such as children
(Cole 2005). Facilitators explained that it would be important to consider in real life risk
assessment to the children attending such sessions as to make sure that staff and other
participants were safe when attending such sessions (Creek and Bullock 2008).

While students were working on the allocated task, which asked them to use scissors to
cut open plastic bottles to be used as pots and containers for planting seeds, participants
were observed struggling with the equipment. This was an experiment and the students
attending this session were full grown adults and this alone should reflect that children
would have serious problems to manipulate and achieve the final end result asked from
them.
Substratum Strand
It is important that all materials and techniques used during the activities should be pre-
tested by facilitators and if any fault or difficulties arise, the facilitators should have an
alternative that would comply with principles of dealing with risk and environmental
hazards (Hagedorn 2000).
According to Hagedorn (2000) and Cole (2005), it is important that participants attend the
session in a safe place to engage within the session and the activities. The simple fact that
the participants are safe and the facilitators provide for them, it’s very important.
Accordingly Johnson and Johnson (2000) states that is important to manage the group risk
as providing not only a safe environment but a space for developing learning as aimed by
the session leaders.
This does not reflect the fact that the facilitators were not aware or were irresponsible
when preparing the session for this kind of client population. It was assumed by facilitators
that participants were able to manipulate the equipment in a safe way. I realise that one
should never assume but, instead test such equipment to make sure that it is safe to be

used (Park 2010). As this was a student exercise, I’m glad that such problems arose as
this gave facilitators and participants a valid learning curve that I’m sure will be part of our
subconscious when preparing future sessions.
Connective Strand
This reflective piece has helped me to look at the way sessions are prepared and the way
the room is set out for the participants. A “mental rehearsal exercise” needs to be
considered as how to run the session as this will give facilitators the idea of what needs to
be changed or modified to achieve the best end results with the participants in a safe
environment (Cole 2005).
Reflecting now on the use of scissors during the activity, it is obvious that this was an
issue of health and safety. The co-facilitators that were at each table to help participants to
do the task helped them handling the equipment. In a real life situation, children could
cause harm to themselves or others before the co-facilitators even had the opportunity to
help then with the task. The health and safety of participants being overlooked when
scissors were put on the table could have caused a massive problem that professionals
are accountable for (BOAT 2010).
Looking back to the day when the activity took place, it is obvious that facilitators
overlooked some important health and safety considerations and this could have impacted

on the safety of participants and on the way that the session was run.
Much of the effort of facilitators to design a session for children from a deprived area in
London was adequate and directed towards orienting participants to promoting health and
well-being (Cole 2008). Not being thorough enough with risk assessments and health and
safety for this particular session gave me an insight into how to become an effective
professional in future (Creek and Bullock 2008).
Section 3: Retrospective Reflection
Group work in Occupational Therapy is paramount to achieving therapeutic results with
any client group. It was observed that clients benefit from attending such sessions and
professionals should use these sessions as important tools that help clients to achieve

recovery. For this retrospective reflection the Fish, Twinn and Purr (Alsop and Ryan 1996)
model will be used.
Factual Strand
University modules provide a good experience of the range of work involved in designing
and setting up a group session and this may help to allay some of the student ‘s fears and
misunderstandings about what is expected of them.
As an undergraduate Occupational Therapy student I had concerns about the running and
delivering of the session, and how to identify the needs for a specific client group. After
attending the module, it became clear that such experience gave me a valuable insight
into what to do with a client group and how to behave in professional health settings as
advised by Cole (2008).
As a future professional, engaging in such learning sessions gave me experience and
called my attention to what areas I need to improve to become a professional that uses his
own skills in a more therapeutic way (Cole 2008, Hagedorn 2000).
Substratum Strand
Understanding the way people react to a different group work was important to appreciate.
As a student this module offered me a starting point from which to develop my practice
and take on new roles.
Connective Strand

The purposes of this module became clear to me after the initial sessions as it was
relevant and allowed me to explore from the perspectives of Occupational Therapists the
group-work itself. By having insight into the current and emerging perspectives and roles
of Occupational Therapists when working in groups, has also given the motivation to
research such subjects in full in a near future.
Reflecting week after week upon the work done with my fellow students gave me a larger
understanding as to where to develop my engagement skills and to develop inter and intra-
personal skills (Cole 2008, Hagedorn 2000).
I have learned that as a future Occupational Therapist I need to challenge my own views,
values and practices as it is an essential part of my continuing professional development. I
want to challenge myself, as a professional in healthcare, not to become immune to
other's needs. Using reflective processes may also be one way to continue to think about
what I know, what I need to know and how I would put this knowledge into practice for the
benefit of my future clients. Therefore on-going self-reflection, self-evaluation and
research, such as the reading of case-studies, will ensure that I stay open to where I may
need to change.
In conclusion I can say that attending this module gave me a different insight into my
abilities and capabilities as a session leader and as a facilitator for future practice. It also
gave me a different perspective about group work that I might have otherwise overlooked
in the past and it also motivated me to explore group-work further as to enhance the

quality of my work with clients.
Word count: 3525 (excluding index page, references and appendix)
References
Alsop, A and Ryan, S. (1996) Making the of fieldwork education: a Practical approach.
Chapman & Hall. UK
Creek, J., Bullock, A. (2008) Chapter 5, Assessment and outcome measures in Creek, J.
and Lougher, (Eds) Occupational Therapy and Mental Health, fourth edition,
Churchill Livingstone, UK
CEBE 2012 (2012) http://cebe.cf.ac.uk/BPBN/casestudy/salford_tla2ii.htm [accessed
29/03/2012]

Cole, B. (2005) Group Dynamics in Occupational Therapy – The theoretical Basis and
Practice Application of Group Intervention. Third Edition, slack Inc., USA
Cole, B. (2008) Chapter 17, Client-centred groups. In Creek, J. and Lougher, L. (Eds)
Occupational therapy and mental health. Churchill Livingstone, UK
British Association of Occupational Therapists (2010) Code of Ethics and Professional
Conduct. The College of Occupational Therapists. London
Davis, M and Rinaldi, M. (2004) Using an evidence-based approach to enable people with
mental health problems to gain and retain employment, education and voluntary
work, British Journal of Occupational Therapy, 67(7), pp. 319-322
Finlay, L. (2001) Groupwork in Occupational Therapy, Nelson Thornes, UK
Gross, R. (2005) Psychology the Science of Mind and Behaviour, 5th
edition, Hodder
Arnold, UK
Hagedorn, R. (2000) Tools for Practice in Occupational Therapy, Churchill Livingstone, UK
Johnson, W. and Johnson, F. (2000) Experiential Learning – Joining Together Group
Theory and Group Skills. Pearson Education Inc., London, UK
Park, S. (2010) Chapter 8. Goal setting in occupational therapy: a client-centred
perspective. In Dunken, E. (Ed.) Skills for Practice in Occupational Therapy.
Churchill Livingstone, UK
Promoting and assessing critical thinking (2012)
http://cte.uwaterloo.ca/teaching_resources/tips/promoting_and_assessing_cri
tical_thinking.html [accessed 29/03/2012]

Appendix 1 – Group Protocol – Older Adults
CREATIVE COOKERY FOR HEALTH AND WELL-BEING
Author: Group X
Session: Scones and Memories
Informing theory:
Canadian Model of Occupational Performance (CMOP) (Polatajko, Townsend, 2007)
focuses on dynamic interactions between three areas: person environment and
occupation; changes in any of these influence occupational performance and role
expectations. CMOP emphasizes on enabling participation in areas of self-care,
productivity and leisure.
Therapist working with a group of clients focuses on occupations that individual needs or
desire to engage with and barriers which may influence occupational performance.
Attention to productivity and leisure is necessary to emphasize on transition in physical
capacity and level of participation in social networks among older adults. Effective
therapeutic intervention would assist in overcoming those barriers occurred from natural
aging process and acquired disabilities during the life span.
According to Erikson’s life stage theory, (Gross, 2005) the members of this group are in

the last developmental stage of life. During this stage the conflict which impacts older
people is ‘integrity vs. despair’. Integrity can be seen as a healthy way of reflecting upon
life and is the inner sense of "wholeness" deriving from qualities such as honesty and
consistency of character. It is up to the individual to choose to reflect upon these choices
and to be successful in actively aging which will promote a feeling of inclusion in society.
Occupational therapists provide a safe and appropriate intervention that give participants
emotional support (Cole 2005).
Purpose:
The purpose of the ‘Scones and memories’ baking group is to:
• Discuss the benefits of having a healthy, balanced diet using the ‘traffic light’ nutrition
labels.
• Develop and/or relearn the necessary skills prepare and bake a food dish.
• Empower members to make decisions, co-operate with others and to follow set
guidelines to achieve the desired end result.
• Promote health and safety within the kitchen environment
• Introduce members to particular adaptive equipment and/or techniques which
will maximise their independence in this activity
• Come together as a group at the end of the session to eat the finished scones
and to encourage members to share any memories they have regarding baking.
Group Membership:
This group is open to older adults (aged 65 and over) of both genders who are recovering
from a cerebral vascular accident (stroke). The group will aim to accommodate clients from
all cultural and socioeconomic backgrounds. The group will take place in the therapy
kitchen area of the local stroke rehabilitation unit on an outpatient basis. The group is set
to run on a weekly basis every Tuesday at 11am.
Clients can be either be referred by a healthcare professional such as their occupational
therapist, stroke nurse or G.P. or they can also self-refer to this group providing that they
meet the criteria.
The criteria for referral to the group is as follows:
• Any older person who has suffered a stroke within the 12 months and is now
discharged from acute hospital services.
• The person has an interest in food preparation and is motivated to attend on a
weekly basis
• The person has the mental capacity to consent to and participate in the group
• Is not acutely physically or mentally unwell at the time of referral

The clients need for occupational therapy intervention is identified as hemiplegia (unilateral
weakness) which can result in impaired range of movement, strength, pain and swelling.
A risk assessment will be carried out with each client based on the information available
from the referral source to determine any risk to self or other members of the group
including the leaders.
The group will be run by two qualified occupational therapists and two occupational
therapy assistants and will be available for a maximum of 12 members and a minimum of
3. This will be an open group with members being able to join at differing stages of their
rehabilitation; this will promote a support network and at the same time allow members to
see how other stroke survivors have progressed through their rehabilitation.
Rationale:
The group aims to increase confidence levels in individuals and improve their
communication skills which will facilitate social inclusion. The rationale is to maintain
occupational performance in the client group (i.e. older people who have suffered a stroke)
and decrease the possibility of occupational deprivation. According to the National Institute
for Health and Clinical Excellence (NICE), depression is approximately two to three times
more common in patients with a physical health problem than in people who have good
physical health (2009). Being depressed might in turn cause the person to avoid partaking
in their usual routine due to lack of motivation. Baking scones was chosen because it was
easy to make it provides the opportunity for the clients to interact whilst enjoying the end
products afterwards. A recent study that explored service user’s engagement in baking
deduced that the opportunity to acquire new skills and confidence while producing an end
product was a motivator in attending sessions (Hayley and McKay 2004). Finally, providing
awareness of food hygiene procedures when working in the kitchen as everyone who
handles food must have the highest possible standards of personal hygiene to avoid
contaminating food and causing illness (Nash, 2006). The importance of maintaining a
healthy, balanced diet is well documented in the prevention of further strokes and
maintaining the health and wellbeing in the older population (NICE, 2008).
Aims:
By the end of this session participants will be able to:
• Undertake a task where scones were made in each group
• Increase confidence levels
• Increase communication skills with the group members
• Remain focused throughout the session.
• Experiment with adaptive equipment in order to maximise independence

• Understand and apply knowledge of the traffic light nutrition labels on food.
• Have formed a support network between group members.
• Feel confident and comfortable in sharing memories with other members of the group.
Outcome Criteria:
Participants will produce a number of scones made accordingly to health and safety
regulations. Nutritional value of produced food will be addressed, and issue of healthy food
consumption will be part of the discussion. Participants during the discussion, will
demonstrate understanding of cookery as a creative activity and its influence upon social
inclusion and physical activity.
The success of the activity group will be evaluated by a feedback questionnaire given to
the participants after their final group session. The clients will also have an opportunity to
give feedback to the group leaders during the last part of the group as well as to reflect on
their own experiences of the group. This is essential in ascertaining whether the group has
met the client’s individual aims and goals as well as possibly influencing how the activity
may be altered to meet the aims more effectively.
Format and Description
TIME ACTIVITY SUPPLIES
AND COST
5 mins INTRODUCTION
Introduce the facilitators
Session aims
Health and safety procedures
Fire drill
5 mins WARM UP – traffic light system food
Give to each group an envelope and asked them to
explain its content to the rest of the group.
Facilitators explain the traffic light system food in a
simple way.
3 envelopes
20
mins
MAIN ACTIVITY – Scones, Cream and Strawberries
or Jam
Divide group into three smaller groups of four.
Preparation of one batch of scones per group plus
Scones
recipe

whipped cream and strawberries sliced.
• Prepare scones using stove
• Demonstrate weighing, measuring and kneading for
dough
• Bake
• Whipping the cream
• Slicing the strawberries
• Clean and tidy
10mins DISCUSSION and SNACK
Reminisce memories – ask participants to talk about a
particular memory while eating scones
Therapeutic Application– how thinking about your past
experiences make you feel?
Plates
Knives and
Forks
5 mins Clean, Tidy and Pack away
5 mins CLOSURE
References:
Cole, M.B. (2005) Group dynamics in occupational therapy 3rd
ed. Thorofare NJ: Slack
incorporated
Gross, R. (2005) Psychology: Science of Mind and Behaviour. London: Hodder &
Stoughton.
Hayley L and McKay EA (2004) ‘Baking gives you confidence’: Users’ views of engaging in
the occupation of baking. British Journal of Occupational Therapy, 67(3), 125 – 128.
Polatajko, H.J., Townsend, E.A, (2007) Enabbling Occupation II: Advancing an
occupational therapy vision for health, well-being and justice. COAT Publications
ACE, Ottawa, ON.
Nash, Claire (2006) ‘Food Safety First Principles’ United Kingdom: Chartered Institute of
Environmental health.2.46.54
National Institute for Health and Clinical Excellence (2009), Depression in adults with a
chronic physical health problem: Treatment and management Available at:
http://www.nice.org.uk/nicemedia/live/12327/45909/45909.pdf [Accessed 18th
January 2012].
National Institute for Health and Clinical Excellence (2008), Stroke: diagnosis and initial

management of acute stroke and transient ischaemic attack (TIA)
Available at: http://www.nice.org.uk/nicemedia/pdf/CG68NICEGuideline.pdf
[Accessed 19th
January 2012]
Appendix 2 – Group Protocol - Adulthood
Group Protocol: Groups in action - Life stage 2
Author: Group X
Session: Vocation sensation
Informing theory:
The focus of the group is for clients to re-establish a meaningful productivity and develop
competence in vocational skills such as preparation for a work interview and writing CV
skills.
This group is based upon the Model of Human Occupation (MOHO) and the primary
occupational domain addressed is Productivity. The group focuses on Competence level
of engagement.
Overview diagram of the group:

Primary
Occupational
Domain
MOHO Exploration Com
Level of
Engagement
Volition
Habituation
Skill
Environment
Self-care
Productivity
Leisure
Self-ca
Produ
Leisur
The MOHO is also linked to client-centred theories of recovery, focusing on recognition of
abilities and meaningful activities, and providing opportunities for change, reflection and
discovery of new values, skills and interests (Mental Healh Foundation, 2012)
Purpose: The purpose of this session is to raise the clients’ awareness of various factors
which will influence their success in applying for a job. This session will focus on
communication skills and appropriate dress code required for a formal interview, and
provide information of Curriculum Vitae (CV) writing skills.
Group Membership:
A total of 8 – 10 male and female adults aged 18 – 55 with mental health conditions in an
acute setting.
*Who are not actively psychotic/suicidal.
*Are able to concentrate and complete tasks within the session
*Are ready for discharge
Rationale:

There is much evidence to suggest that unemployment has an adverse effect on a
person’s health and wellbeing (Warr 1984). In addition it has been shown that
unemployment results in an increased risk of suicide in the general population (Lewis and
Sloggett, 1998). The National Service Framework for Mental Health (DH, 1999) stipulates
that services should exist to prioritise employment amongst individuals with mental health
problems as well as to reduce the discrimination associated with this client group and
promote social inclusion.
This session cites the social model of recovery which is focussed on enabling clients to
regain their roles and activities within their communities. Social inclusion is a vital part of
recovery as taking part in mainstream activities such as employment
Aims:
By the end of this session participants will be able to:
• Identify and discuss appropriate communication techniques for job interviews
• Identify suitable dress code for job interviews
• Gain advice on how to write an effective curriculum vitae (CV)
• Be motivated to actively reflect on the processes involved in gaining
employment
Outcome Criteria:
Verbal feedback from participants at the end of the session.
Occupational Self-Assessment (OSA)
Follow up review of participants after 6 months
TIME ACTIVITY SUPPLIES AND
COST
5 mins INTRODUCTION
Facilitators introduce themselves and the aims

of the session
Health and safety
Confidentiality
10
mins
WARM UP
Role play activity: Job interview communication
techniques with XXX
Brief discussion
20
mins
MAIN ACTIVITY 1
In small groups read through 3 CV’s and
highlight any areas which may need changing
and why, allow participants to suggest things to
be included in the CV. One facilitator/co-
facilitator per group?
15
mins
MAIN ACTIVITY2
In small groups participants are to be shown a
variety of photos of people in various outfits.
Group members to write on the paper and
discuss what is appropriate/not appropriate for a
formal interview and why.
X to arrange
printouts of photos
5 mins DISCUSSION
Outcome measure: verbal feedback
5 mins CLOSURE
References:
Creek, J. (2008) The Occupational therapy and Mental Health 4th
ed. London: Elsevier
Churchill Livingston
Cole, M. (2012) Group Dynamics in Occupational Therapy 4th
ed. Thorofare NJ: Slack
Incorporated.
Department of health (1999) The National Service Framework for Mental Health. London:
DH
Lewis, G Sloggett, A (1998) suicide, deprivation and employment in the 1930s and the
1970s. Bulletin of the British psychological society, 32, 309-14
Mental Health Foundation (2012) recovert [online]. Available at:
http://www.mentalhealth.org.uk/help-information/mental-health-a-
z/R/recovery/. Accessed on 22/02/2012.

Warr, P (1984) Job loss, unemployment and psychological well-being. In: V.L. Allen, E van
der Vilert, eds. Roles transitions. New York: Plenum press.
Appendix 3 – Client Population and Group Protocol
– Children and Young People
Client population
Population choice
The client choice for the gardening group is boys and girls aged between 9 and 11 years
old and of any ethnic or religious background. The client group will be from the ‘healthy
population’ which means there is an absence of any significant disabling medical or
cognitive condition, which would affect their ability to consent to and participate in the
activity session.
The clients will all be pupils attending a particular primary school in the North East London
borough of Hackney, an area which has high levels of crime, poverty and unemployment,

Therefore, the children may be at risk of abuse or neglect and possibly may be already
known to the local authority child services team.
Context
The session is part of an educational programme that is run for 8 to 12 weeks.
This is an open group, and it is available to all students from the primary school.
The participants can be referred by social services and from their personal tutors at
school. The students have been assessed, and an appropriate risk assessment has been
done to determine the each participant’s suitability to attend the session.
Cultural: Participants attend the session twice a week, as part of a therapeutic
programme within after hours’ school activities.
Physical: the clients are to attend the session in the Therapy room 1 which is easily
accessible, well-lit, with sufficient chairs, and resources for the intended activity, as well as
a garden space located outside in the school grounds. Tools are stored in the therapy
room and in a small shed, in the garden.
Social: the group is run by two OT’s. Maximum members will depend on staff availability
but is recommended that no more than 10 participants attending the session. The students
may hold social expectations; establish roles within the group and create friendships with
other members.
Personal: participants aged 9-11 years, both male and female from the same school with
poor socioeconomic and educational status.
Need for Occupational Therapy:
Application of approach – ‘prevention rather than intervention’.
Referrals from local agencies social services, health visitor, school teacher parents, and
carers.
To maintain/improve/encourage:
Supports to environment – become eco-friendly- recycle
Further educational programs on living the school

Law-abiding and positive behaviour in and out of school
Healthy lifestyle
To reduce:
Social isolation
Deprivation
Risk of crime and anti-social behaviour in and out of school
To develop:
Responsibility
Sense of belonging
Enterprising behaviour
Positive relationships
Choice not to bully or discriminate
Approaches to intervention:
The behavioural approach can be used to as a motivator in engaging people in activities.
Skinner states that providing positive reinforcement will enhance and maintain appropriate
behaviour in the children (Gross, 2005). In these sessions, apart from getting appropriate
feedback from facilitators, the reward for the children’s hard work will be produce that can
be eaten in a few weeks’ time and also used to feed their pets.
As stated by Albert Bandura in social learning theory, behaviour is learned from the
environment through the process of observational learning. Children observe people
around then behaving in different ways and will imitate the behaviour that they believe will
earn approval (Gross, 2005).
The ground rules of the session will be agreed at the beginning and by providing a safe
environment for the children to interact after school, 'Greens for me, and my pet’ will
promote independence and prevent antisocial behaviour.
Group Protocol: Groups in action - Life stage 3
Author: Group X
Session: Greens for me and my pet
Informing theory:

Occupational therapy intervention is based on the Model of Human Occupation (MOHO).
Model explains persons’ desire to participate in occupation (volition), how behaviour
patterns influence activity (habituation), and persons’ experience of the world through own
body (performance skills). According to MOHO, environment (social and physical) as an
inseparable element of person’s life, offers opportunity, recourses or constrains to
participation (Kielhofner, 2008).
Motivation (Volition) for gardening involves opportunity to demonstrate own creativity while
designing the plant pot, indentify worth attached to the project and desire to participate in
gardening. It is influenced by student enjoyment; effectiveness while performing and
satisfaction from participating in gardening.
Habituation refers to patterns of behaviour influence how activity will be performed.
Students integrate their individual physical, cultural, social and temporal context during
gardening and learn about habituations of peers.
Performance capacity is the ability to participate in activity based on physical and mental
health components. It focuses on subjective experience of performing – students’
communication, interaction and perceptual motor skills will enable to learn new skills.
Environment, for this session, will referrer to involvement in a social group and engage in
change. Students will have an opportunity to explore group interactions and its impact on
individual behaviour, roles and expectations.
Purpose
Session promotes social interactions, play in safe environment, creativity and sense of
achievement.
As a group projects opportunities are created for unique roles, responsibilities for each
member to grow individual pot with vegetable.
Group Membership:
The group is open to 9-12 children of mixed sex and facilitated by an occupational
therapist and 2-3 assistants as co-facilitators. The ratio of children to facilitators is always
at least 3:1.

Rationale:
This session is based on the government’s initiative ‘change for life’ which aims to get
families to be healthier and happier by becoming more physically active and preparing
meals from fresh products, (NHS, 2012) ‘Greens for me and my Pet’ aspires to incorporate
the responsibility of growing vegetables which would be harvested after a few weeks, used
to prepare salads/sandwiches and also feed the children’s pets. Research evidence
suggests having specific, achievable goals can enhance and sustain motivation and lead
to improved levels of performance (Rodger, 2010).
Since it is an after school session that is run twice a week, it will provide a safe
environment for the kids to be physically active and enhance their creativity whilst giving
parents a break from childcare. The session will also give children a chance to enhance
their interpersonal skills and provide a sense of belonging (Rebeiro 2001).
Children may experience occupational deprivation due to the social environment and their
status. Occupational Therapist (OT) will work with local school to fulfil potential regardless
of background. Placing attention to child well-being in early life, OT creates opportunities
for successful development and prevents risk of developing damaging habits or behaviour.
For example, after school group for children affected by poverty, poor housing and
isolation provide steps towards occupational change, growth and encourage to positive
community contacts and prevents gang culture (Department of Education and Skills,
2004).
Aims:
• Facilitate verbal social interactions and social skills
• Develop a sense of self-efficiency and achievement
• Facilitate concentration and attention
• Teach responsibilities, new skills, and new interests
• Raised awareness about healthy eating and recycling
• Provide opportunities to play in out of school hrs, in a safe environment
• Facilitate creativity
• Receive effective support earlier if difficulties arise
Outcome Criteria:
At the end of the session, each child would have:
• Maintained concentration throughout the session

• Actively listened to instructions and complete tasks appropriately
• Communicated appropriately with peers and facilitators
• Shared equipment’s and other materials with group members
• Adhered to health and safety procedures whilst using equipment provided
• Attend and enjoyed school and after school session
• Develop feeling of safety ,enjoyed and achieved growth of desired vegetable
• Agreed to look after plants after in-between sessions.
TIME ACTIVITY SUPPLIES AND
COST
5 mins
INTRODUCTION
Health and safety, toilets
Ground rules
Use of equipment
Roles
10
mins
WARM UP
To pitch a penny into a pumpkin
Preparation:Carve out a pumpkin (alternative
use a large bowl) and line the inside with plastic
or aluminium foil. Make the top opening big.
Playing the Game:Place the pumpkin (bowl) a
couple feet away. Give each player one to two
pennies. Every time a penny goes into the
pumpkin, a piece of candy is won.
Large bowl or
pumpkin.
About fifty penny
coins
15
mins
MAIN ACTIVITY 1
Creating plant pot from recycle materials and
decorating it.
Making a watering can from recycle materials
Recycle materials
like milk bottles, juice
boxes, candy tins,
yogurts pots.
Markers, pens,
paper, glue or tape.
2 mins
BREAK
Physical exercise activity – stretching
10
MAIN ACTIVITY2
Planting up
Soil

mins Within the subgroup discuss how care for
vegetable
seeds
10
mins
PRESENTATION OF WORK
Explanation of created pots
Compare pots and group choice of most
creative one
5 mins
CLOSURE
Cleaning the room
References:
Department of Education and Skills (2004) Every child matters: change for children.
Available at:
https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DfES/1081/20
04 [Accessed on 19th Mach 2012]
Gross, R. (2005) Psychology: Science of Mind and Behaviour. London: Hodder &
Stoughton.
Kielhofner, G. (2008) A Model of Human Occupation: Theory and Application, 4 th ed.
Baltimore: Lippincott Williams and Wilkins.
NHS(2012) Healthy Living Tips. Available at: http://www.nhs.uk/Change4Life/Pages/why-
change-for-life.aspx [Accessed 19th
March 2012].
Rebeiro K (2001) Enabling occupation: the importance of an affirming environment.
Canadian Journal of Occupational Therapy, 68(2), 80-89
Rodger, S (2010). Occupation-Centred Practice with Children: A practical Guide for
Occupational Therapists. United Kingdom: Wiley- Blackwell. 116.

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