Saturday, August 8, 2015

Patient Confidentiality- A Therapist Duty

Patient Confidentiality- A Therapist Duty

The Duty....
  • To Maintain confidentiality means that...a clinician may not disclose any medical information revealed by patient or discovered by a clinician in connection with treatment of a patient. 

Maintaining Confidentiality:
  • Is to allow the patient to feel free to make a full and frank disclosure of information to the clinician with the knowledge that the clinician will protect the confidential nature of the information disclosed.
Benefits of Full Disclosure:


  • Enables the clinician to treat conditions properly and appropriately.
  • n return...for the patient's honesty, the clinician should not reveal confidential information without the patient's express consent unless required to disclose the information. 
Only Specific Exceptions...
  • Exceptions to the rule: Where a patient threatens bodily harm to himself or herself or to another person. 

Legal Obligations:

  • Courts use ethical obligations...as the basis for imposing legal obligations.
  • Patient confidentiality- a legal and ethical duty

  • Courts allow a cause of action for a breach of confidentiality against a treating clinician who divulges confidential medical information without proper authorization from patient.

Breach of Confidentiality:
  • Is a disclosure to a third party...without patient consent or court order...of private information that the clinician has learned within the patient- clinician relationship. 
Types of Disclosure: 
  • Can be oral or written, by telephone or fax, or via e-mail or health information networks.
  • The medium is irrelevant. 

Current Law:
  • A 'crazy quilt of state and federal law' protecting patients' confidentiality.
  • Both federal and state constitutional privacy rights, legislation, and regulation governing both medical records and licensing, and specific legislation designed to protect sensitive information. (e.g., HIV test results, genetic screening information, mental health records, and drugs and alcohol abuse rehabilitation information.
Patient Consent to Release Confidential or Privilege Information:

  • Information in a patient's medical records may be released to third parties...ONLY if the patient consented to such disclosure.
  • The patient's express authorization (documented writing) is required before the medical records can be released. 
Sample....Interested Parties:

  • Patient's attorney or insurance company; patient's employer (unless a worker's compensation claim is involved): member of the patient's family (except where the family member has bee appointed patient's durable power of attorney for health care) government agencies; and other third parties.
HIPAA RULES:

  • Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. 
  • Create additional Rules...under privacy regulations, covered entities may usually release protected health information without authorization only to facilitate treatment, payment, or healthcare operations. 

Manage Care Organizations (MCO):

  • Require members (Pt) to sign a general release form on enrollment in the plan. 
  • Pt authorizes release of medical information to MCO.
  • Pt acknowledges MCO's right to conduct utilization review program of health services and to coordinate benefits/reimbursement.
Before forwarding medical records to MCO, utilization review programs or other health programs...Clinicians & hospitals should get a signed copy of the patients release and medical records.


Who Can Consent To The Release?

  • Who may grant permission...is governed by state law which varies from state to state.
Generally granted to:
  1. The patient, if competent adult or emancipated minor.
  2. A legal guardian or parent if the patient is a minor or a child.
  3. The administrator or executor of the patient's estate if patient is deceased. 
What has to be in the release?

Typical elements-a valid general release:
  1. Patient's name & identifying information.
  2. Address of the health care professional or institution directed to release the information.
  3. Description of the information to be released.
  4. Identity of the party to be furnished the information.
  5. Language authorizing release information.
  6. Signature of patient or authorized individual.
  7. Time period for which release remains valid.
Implied Consent and Public Policy Exceptions or Required Disclosures:

#1.)- Even if the patient has not expressly authorized disclosure of medical records, such consent is implied from the patient's acceptance of treatment or hospitalization. 

#2.) When a patient is transferred from one health care practitioner/ facility to another.
  • Disclosure of confidential patient information is necessary to ensure continuation of patient care or treatment. 

Safeguard Confidences: 
  • If probability a patient will inflict serious bodily harm on another.
    • The clinician should take precautions to protect the intended victim and notify law enforcement authorities. 
  • Communicable diseases, gunshot, and knife wounds should be reported.
  • Th clinician's duty of confidentiality at times must give way to stronger countervailing societal interests. 

Management Safeguards & Security:

  • Have contracts with system vendors and consultants participating in data repository reviewed by attorney. 
  • Have comparable confidentiality and security policies.
  • Implement security controls over sensitive information (e.g., HIV status, pregnancy termination,history of mental health problems, or alcohol and drug abuse).



Management Safeguard and Security:

  • Maintain good system security.
  • Train staff
  • Secure agreements concerning confidentiality and security.
  • Have security experts assess security of clinical date repository.
  • Require that users who access information sign appropriate user agreements.
Sample Office Procedures:
Attach an office form to any request for medical records.

The form would have a checklist:
  • Date of receipt of the request
  • Date of the receipt of the copy of the patient's release form
  • Date that the medical records were authorized to be sent to the requester.
Why Protecting Patient Confidentiality Is So Important:

  • Ethics and law involved...long before the information highway was envisioned. 
  • Old laws/ethical precepts...do not always fit neatly with today's computerize systems, they will gradually catch up. :)
  • Clinicians should protect information to the extent possible to comply with the 'crazy quilt' of federal and state laws. 

Clinicians Should...

  • Become familiar with the laws involving the duty to maintain confidentiality.
  • Any breach in confidentiality-even one that seems minor-can result in mistrust and, possibly, a lawsuit and/or disciplinary action.



Thursday, August 6, 2015

RECL 197: Self Analysis Paper

RECL 197: PERSONAL GROWTH AND REFLECTION PAPER
We wrote these papers to make the unknown known, because if we do not out our own cobwebs how can we expect our client to? In order to be a good therapist you need to be comfortable in your own skin-people pick up on this confidence and it makes them feel more comfortable around you-and more likely to open up to you.

OVERVIEW

Task: To conduct personal reflection about your most difficult and most positive experiences and to apply academic learning.

Purpose: Apply theory and concepts to your life and to gain greater self-awareness.

Please Spend Time Thinking About Your Life. 

1. Please determine the most difficult experience of your life (or it could be the worst series of experiences or the worst period).
(Example:  being homeless was the overall awful experience and within it there were series of experiences that were difficult and yet, they were directly connected to this overall chronic trauma/difficulty experience of being homeless).

2. Please consider your childhood.  Consider racism, parental dysfunction, oppression, sexism, abuse (of which has many variations that cannot be seen), drug abuse, depression, rage, siblings/extended family, schooling, peer experiences/groups, etc.). Some people have a hard time and feel that they did not have any lowest point but everyone does. Email me if you need help.

3. Then determine the best experience of your life.

Required Format: This paper can be a report format where you have headings for each required section listed below. You can list discussion information when applicable. You will lose points if you do not respond to every single requirement listed.


WRITTEN REQUIREMENTS

I. PART I:  The most challenging time/experience of my life (approx 4 pages total)


A. 1 page—no more than 1.5 pages. Write a synthesis of my worst experience:  Briefly synthesize the overall experience from a literal perspective. What happened –share this in a way that is concise but touches upon what happened and how this affected your mental, emotional, physical, social, spiritual, cognitive wellbeing (do not need to mention every single domain but ensure that you consider all 5 domains when you share). This is difficult because you have to get to the core of the experience and tell only the core essence.

B. Theoretical/Literature Application:  Analyze/Discuss your experience using theoretical lenses (psychoanalysis, enneagram, and attachment theory).

1. 1 page total--Use Psychoanalytic Theory: I will help you to use psychoanalytic theory to examine yourself and your unconscious. Please read the below 2 scenarios and respond to the psychoanalytic question set that best fits your situation.

Situation A: Your worst experience occurred under the age of 18.

a. How was I affected? Identify the ways in which this experience affected your emotional, social, physical, cognitive (ability to learn/think etc.), spiritual well being as a child, teenager and now.

b. Nature of the pain. How would you characterize the major aspects of the wounding? (Abandonment? Neglect? Betrayal? Abuse? Racism? Sexism? Homophobia?).

b. How does this wounding affect me today? Consider the following questions so you can respond to this question thoroughly.
In what ways does the above issue(s) show up today in your intimate relationships and behavior?
Do you avoid a certain type of experience because of your difficult experience in childhood?
Does your partner or best friend exhibit similar characteristics to your mother or father figure (domineering, disinterested, demanding, unavailable, cheating, suffocating, etc.)? Or did your best friend/partner hurt you in a similar way?
FYI = This is not a mistake. This is the unconscious playing out so you can re-visit your wounding and choose to heal the original wound of childhood.


Situation B:  Your worst experience was after age 18.

a. How was I affected? Identify the ways in which this experience affected your emotional, social, physical, cognitive (ability to learn/think etc.), spiritual well being then.

b. Link the past to the present. How are the above issues showing up today in your intimate relationships and behavior? To answer this question, consider the following prompts to help you to brainstorm.
Consider how your worst experience repeats a childhood pattern? Did a friend abandon you and ironically, a parent abandoned you in the past? This might not be obvious at first and will take deep contemplation.

2. 1/2 page. Apply Attachment Theory to My Life. 
a. My attachment imprint. Identify your attachment type with each parent.
Model of Self (dependence)
Positive – as a child the self that is seen as worthy of love and attentio

Resources/Help: Read about the theory using the posted materials in Modules of Canvas. Use the 4-window grid by Bartholomew & Horowitz (1991) and Bartholomew, (1990) to identify your attachment type to your primary parental figures (regardless of whether or not they were present or absent).

3. 1 paragraph. Enneagram.
a. How does knowing my enneagram type give me insight into my worst experience?


C. ½ page. List 3 Irrational Beliefs. 

1. Write a list of 3 irrational beliefs that you adopted as a result of your worst experience.  Irrational beliefs are simple, intensely honest, and often have language of a child.

Examples of Irrational Beliefs:  
“All people with money are egotistical jerks”.
“The only way to survive is to drop out of society”.
“To be invisible is the only way I can escape uncomfortable situations”.
“I am worthless.”
“I am not lovable.”

2. For each belief explain why you have each irrational belief in 2-3 sentences for each irrational belief.
3. For each belief: Is this irrational belief healthy for you today?  Yes or No
4. For each belief: Identify the degree to which you are open to changing each core statement. 1 sentence each.
5. For each belief: Re-write a healthy replacement belief that you can adopt as true and healthy. One sentence for each. If your irrational belief is “I am unlovable” the replacement could be “I am lovable.”

Irrational beliefs arise when we have an emotionally charged experience. In an effort to cope, we adopt a new belief about others, the world, or ourselves. When you do so you become imprinted with a core belief about who you ‘think’ you really are or ‘what is possible’ based on this lie (core belief). The truth is that you are beautiful, smart, loving, capable, and amazing.

D. 1/3 to 1/2 page. Coping and Defense Mechanisms:  What Coping Mechanisms/Defense mechanisms did you use in order to survive your personal crisis (worst experience)?

1. Identify AND describe how you employed at least 2 Defense Mechanisms from Freud’s Psychoanalytical Theory in order to survive. Denial? Sublimation? Intellectualization? Please see the Educational Session handout on Canvas.


2. Write 2-3 sentences about 2 other coping mechanisms you used to survive your ordeal.
Examples: Numbing out?  Drugs?  Sex?  Avoidance? Intellectualization? Cyberworld? Hiding/Isolation (in a relationship or a place like home)? Reading all the time? School? Overwork?

Use your course reader, PowerPoint theory teach-in, and internet to look up different published Coping Mechanisms techniques that you used to survive.

E. 1 paragraph. Positive Traits:  What positive and healthy traits and/or characteristics did you gain as a result of this adversity? Even the worst of experiences help us to develop positively. What did you learn that is towards a positive end?  For example, “I can persevere through the darkest of times” or “I am capable of forgiveness.”

F. 1 paragraph. Career Connection to Pain/Dysfunction:  What is the relationship between your worst experience and your major? (It does not matter if RT was not your first choice or not. What matters is that now you are in RT….so what is the connection?)?

Hint:  often we choose our major for unconscious reasons….now, perhaps, you can see a deeper reason for your career? Do you want to help people because you never received the kind of help/love that you needed?  Do you have more compassion or awareness because of your worst experience?


II. PART 2:  My Peak (best or most proud) Experience (approx 2-3 pages)

Analyze yourself through your greatest experience.   Please contemplate an experience of which you have the greatest pride (or series of connected experiences). The below requirements are repeated from above so you can use that as a guide. Use all of the information above to help you to know how to thoroughly respond to each prompt.

A. 3/4 page. Write a synthesis:  Briefly synthesize the overall experience from a literal perspective. What happened –the basics?

B. 3/4 page. List 3 Core Beliefs:  Identify 3 core beliefs that came about as a result of your Peak Experience. Examples: “I am extremely resilient” or “I am really smart” or “I can do anything if I just decide to do it.”

1. Identify 2 core beliefs that arose because of your peak experience.
2. List 2 beliefs and write 1-3 sentences about WHY each belief arose.
3. For each belief imagine how, in 5-10 years, this SAME belief could eventually become limiting to your holistic health. This is not easy. Write 2 sentences for each core beliefs.
Example:  “I can do anything” might eventually push me to become an overachiever which in the short-run is helpful but in the long run will lead me into overwork and not paying attention to my body or family.

C. 1/2 page. Coping Mechanisms:  What coping mechanisms did you use towards your peak experience?  See above description.

D. 1 paragraph. Career Connected to Joy/Strengths:
Your peak experience occurred in part because of your joy and because of your existing strengths. What is the relationship between your peak experience (joy and strengths) and your choice of major (It does not matter if RT was not your first choice or not. What matters is that now you are in RT….so what is the connection)?

E. 1 paragraph. Positive Traits/Characteristics:  What positive and healthy traits and/or characteristics did you develop as a result of this experience?  See above.


III. Conclusion
In 4-5 sentences, what did you learn about yourself because you wrote this paper (i.e., How did the process of writing this paper affect you)? In other words, what insights did you gain because of this paper?

A Little Anatomy

A Brush Up on Human Anatomy 

In the past there have been like 1-3 questions on Anatomy: but we need to cover all of the bases.

photo from: 
https://pleasureinlearning.files.wordpress.com/2012/09/anatomical.jpg


Bones

photo from: http://www.onlinehumananatomycourse.net/wp-content/uploads/2013/01/Human-Skeleton.gif



Inside the Human Skull Bones (Because we spent almost a week on this in class)

photo from: http://www.bing.com/images/search?q=Inside+human+skull&view=detailv2&&id=30C9BCE840C871672281036034DC7D8DDBBC3232&selectedIndex=14&ccid=89qoa6hD&simid=608025189176574673&thid=JN.CDs%2bskTgxomPPG1%2b1j0uvg&ajaxhist=0

Muscles




photo from: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0sJc7bChX-vbtxCDhz0J0akucK3J12IQwbvxDnkSllHwclkfEtCuRSNr0UWE_bYeCur6Ai1w_UM_nqIqRvkZLN7UFe5qvqBLjVCEn_-tYCvUcVcmRr4YrJ413J0ZBzrUen7bTh_dYUkQB/s1600/Human+Anatomy+Muscle+Diagram.jpg


Recl 197: Treatment Facilitations

TREATMENT SESSIONS: FACILITATIONS, AND PROTOCOLS

TREATMENT SESSION:  Facilitate one session utilizing one type of Recreation Therapy treatment intervention. 

Angelina
Jonathan
04/19/15
197
Brain Gym Session Protocol
1.      Session Title: Brain Gym
2.      Rationale/Justification:
     Brain gym activities are beneficial to people with a variety of cognitive and physical disorders. Some examples would include depression, dementia, stroke recoverers, parkinson’s patients, memory loss, and many other diagnoses. Brain gym can also be directed towards children with learning disabilities, such as dyslexia. Even though brain gym helps all of these population, it is beneficial to anyone.

3.      Anticipated Outcomes and Goals:
     Clients will identify the connection between mind and body.
     Clients will learn brain gym exercises.
     Clients will learn about how much water is necessary to keep the nerve network alert and optimal for learning.
     Clients will feel a change in mood at the end of the brain gym session.

4.      ICF CODES:
     d163 Thinking: Formulating and manipulating ideas, concepts, and images, whether goal-oriented or not, either alone or with others, such as creating fiction, proving a theorem, playing with ideas, brainstorming, meditating, pondering, speculating, or reflecting.
     d710 Basic interpersonal interactions: Interacting with people in a contextually and socially appropriate manner, such as by showing consideration and esteem when appropriate, or responding to the feelings of others.
     b4550 General Physical Endurance: functions related to the general level of tolerance of physical exercise or stamina.
     b1643 Cognitive Flexibility: Mental functions of changing strategies, or shifting mental sets, especially as involved in problem solving.
     d410 Changing Basic Body Position: Getting into and out of a body position and moving from one location to another, such as getting up out of a chair to lie down on a bed, and getting into and out of positions of kneeling or squatting.
5. Who:
     People with depression can benefit from participating in group exercises encouraging socialization
     People with dementia can improve memory, repetition, and overall mood through the brain power exercises.
     People with physical impairments, such as stroke recoverers and parkinson’s patients can help improve their motions through repetitions of exercise, as well as improve memory and cognitive functions.
     Brain gym can help benefit anyone by boosting brain power and increasing the connection between mind and body.

6. Group size:  Anywhere from 2-25 people would be the recommended group size for this treatment.

7. Materials / Equipment:
     Case of water bottles
     Brain gym descriptions
     Ties for water bottles
     Writing utensils (2 for each client)
     Paper for each client
     Chairs
     Whiteboard
     Dry erase whiteboard markers

8. Environment / Setting the tone:  
a.    Certain actions/information towards which we will pay attention:
     We will pay attention to the clients’ actions during the exercises, and provide feedback. We will also maintain eye contact and be attentive to clients’ nonverbal communication.
b.    Voice tone: 
     During the facilitation we will sustain a calm, relaxed, and professional voice tone in order to make our clients feel comfortable.
c.    Setup of the room and group:
     Appropriate lighting; not too bright nor too dim
     Group will sit in chairs which will be in a circle formation
     Underneath chairs will be a water bottle with brain gym description attached, paper, and two pen colors.
d.    Where we will be:
     Classroom setting
e.    Why we will do it this way:
     We will facilitate the session in this ideal environment in order to create a positive and comfortable ambiance that can foster participation and treatment outcomes.

9. Evidenced based practice:
     A study was done to examine the effects of Brain Gym on academic engagement for children with developmental disabilities. The study was done to see the benefits on these children with Brain Gym being implemented in their schools. Brain Gym was compared to a similar intervention of physical exercises.

Watson, A., & Kelso, G. L. (2014). THE EFFECT OF BRAIN GYM ON ACADEMIC ENGAGEMENT FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES. International Journal Of Special Education, 29(2), 75-83.

     The article is about the aging process our brains go through and memory loss associated. The article gives a suggestion that exercising the brain with cognitive games may lower the risk of Alzheimer’s disease.

Larson, C. (2008). KEEPING YOUR BRAIN FIT. (Cover story). U.S. News & World Report, 144(4), 41-49.

10. Logistics and Setting the Tone: We will address the following rules: This is challenge by choice. We would like for you to participate in all we have to offer, but it is your decision.
     Overall intended outcome: Clients will feel a change in mood at the completion of the session, shown through the mood scale assessment.
     We will initially thank everyone for taking time out of their day to be present.
     We will then introduce ourselves to the class.
     We will grab clients’ attention by asking them to raise their hand if they have ever heard of Brain Gym before. Then have someone reach under their desk to grab the water bottle and read off the description of brain gym tied around it.
     We will then discuss the rest of the definition of Brain Gym to the class.
     We will then explain the importance of water for this session. Everytime we say PAUSE, the class is invited to take a sip of water.

11. Directed Education:
Brain Gym Treatment Session Plan
Content
Time- minutes
Notes
Setting the tone
-Introduce Ourselves
-Challenge by Choice
-Start assessment

0-1 minute
- Speak at appropriate volume
- Appropriate body language
- Make sure to make clients feel comfortable and safe
-Instruct everyone to start assessment that is underneath their chair. When completed sit and wait for instruction.
Opening Question
-Raise your hand if you have ever heard of Brain Gym.
2-3 minutes
-Clients will share
- Clients will then be directed to look under their chair for the Brain Gym description. Then have someone read it aloud.
(Activity #1)
Brain Gym Definition
- What is it Brain Gym?
     Facilitators Define
-Water importance

1-2 minutes
-Read the definition from our protocol.
-Explain importance of water
-Explain water “PAUSE” rules for session. “When we say PAUSE any time during the session, we invite you to pause and take a water break.”
Activity Starts
-Exercises begin


20 minutes
-Have someone pick a paper from the bowl of exercises. -Have them read the exercise aloud to the class.
-Facilitators then describe importance of the exercise and what it helps with.
-Facilitators then start the exercise.
-One person demonstrating while the other talks step by step. The whole class should be following.
-Do the exercise as many times or as long as stated on the paper.
-Have the next student pick an exercise and repeat again until 20 minutes is up.
 If double doodler is picked...

5 minutes
-Have students reach under chair to grab paper and pens, find an open desk spot around them. Then instructions will be given.
-Bring it back to circle after

Closure
5-10 minutes
-Have everyone circle back up.
-Complete ending assessment that will be handed out
Sharing
5-10 Minutes
-Ask: Did anyone’s results different on the mood scale after the Brain Gym session? How did the results differ?
-Have everyone share how they feel after session.
-Thank everyone for participating.

12. Debriefing Questions:
1. Did your mood change from start to end?
2. How do you feel after the session?
3.What did you learn today?

4. Would you continue to use Brain Gym in the future?

BRAIN BUTTONS
Benefits: Increases blood flow to the brain, water and extra blood flow turns the brain “ON” and improves attention for tasks


ARM ACTIVATION
Benefits: increases blood flow to arms, stretches out chest


CROSS CRAWL
Benefits: Helps with spelling, writing, listening, reading and comprehension by coordinating the left and right brain.


LAZY 8’S
Benefits: Improves visual attention and eye mobility needed for reading.


HOOK UPS
Benefits: Improvement of mood and lessening of anxiety.


THINKING CAPS
Benefits: Helps with spelling, short-term memory, listening ability and abstract thinking.


THE ELEPHANT
Benefits: Activates all areas of the mind/body system.


ENERGY YAWN
Benefits: Relieves stress that interferes with learning and performance.


CALF PUMPS
Benefits: improve concentration, attention, comprehension, and endurance


POSITIVE POINTS
Benefits: relieves emotional stress and improves memory



DOUBLE DOODLE
Benefits: improves coordination of both hands, hand-eye coordination, and spatial awareness

                                               

THINK OF AN X
Benefits: strengthens neural connections between left and right hemispheres of the brain


Brain Buttons-index and middle finger over carotid arteries, other hand on navel
Stimulating the carotid arteries to supply fresh oxygenated blood to brain. >>The motion helps reestablish directional messages from parts of the body to the brain and the visual system, helping to improve the body to brain communication for reading, writing, speaking and following directions.


Arm Activation- Reach your right arm straight up toward the ceiling. Place your left hand above your right shoulder on the arm muscles. Slowly and gently exhale through your mouth while pressing your right arm against your left hand for about eight seconds. Exhale as you squeeze arm. Inhale as you relax the pressure. Repeat toward the ear, away from the ear, and to the rear of the ear.
>>This exercise lengthens the muscles of the upper chest and shoulders. Gross and fine motor movements originate in these regions of the body. This exercise relaxes and coordinates the shoulder and arm muscles to prepare for handwriting, spelling, and typing.



Calf Pumps- Put your hands behind your back and extend your left leg straight out behind you so that the ball of your foot is on the floor and your heel is off the floor. Your body should be slanted at a 45 degree angle. Exhale and lean forward while pressing your left heel against the floor. The more you bend your front knee, the more lengthening you will feel in the back left calf. Inhale and raise yourself back up. DO THIS THREE TIMES, then alternate to the other leg.
>>This exercise causes the muscle fibers in your calf to elongate. Stretching the calf helps realign any disorganized fibers in the direction of the tension. The more these muscle fibers are stretched, the greater the length developed by the stretched muscle.  The calf pump also improves concentration, attention, and comprehension.




Positive Points- The positive points are located right above the center of each eyebrow halfway to the hairline. You may find a slight bulge at each point. Once you find the points, place three fingers of each hand on these points. Close your eyes and hold the points lightly for the course of six to ten slow, complete breaths.
>>These positive points help improve blood flow to the head, relieve headaches, and release emotional stress. Touching these points brings the brain response of stress from the mid brain to the pre frontal cortex, allowing for a more rational response.


Think of an X- Close your eyes and visualize the letter X. Notice how your vision is like the X. Your eyes coordinate to connect the left, right, upper, and lower visual fields around a point of focus. Notice how the X is symmetric and relates to the organization of your body, just like how each hip coordinates with the opposite shoulder.
>>The X represents the ability to cross the midline connecting the right and left visual fields, right and left sides of the body for movement, and both hemispheres of the brain for thought processes. The X is a reminder to use both eyes and both sides of the body. This exercise reinforces the whole-brain and improves your coordination and nerve communication between the different areas of the brain.
_________________________________________________________________________________

                                                           
PROTOCOL – Aromatherapy Treatment Session
By Brittany and Caitlin 

1.      Title:  Aromatherapy Treatment Session
           
      2.   Rationale/Justification for facilitating this session:   

Aromatherapy is an alternative medicine which utilizes essential oils in order to improve a person’s health whether it be physically or mentally. The brain is heavily connected to the sense of smell otherwise known as the olfactory system. When we smell something, the limbic system part of the brain triggers emotions and memories. It is through this facilitation, that the clients will learn more about the healing effects of aromatherapy and possibly use it as an option to help cope with emotional stress.

      3.  Anticipated Outcome:            
The anticipated outcome of this treatment session is to have participants experience aromatherapy through the most common avenue: smell. As well as to understand how aromatherapy can help manage emotions and stress. It is also desired that participants learn about how different effects can be achieved from varying essential oils.
   
 4. ICF CODE(s):      
The three targeted ICF codes that help to explain the functional change and skill development outcomes of this treatment session are handling stress and other psychological demands (d240), looking after one’s health (d570), and retrieval of memory (b1442) :
       d240 Handling stress and other psychological demands: Carrying out simple or complex and coordinated actions to manage and control the psychological demands required to carry out tasks demanding significant responsibilities and involving stress, distraction, or crises, such as driving a vehicle during heavy traffic or taking care of many children.
       d570 Looking after one's health: Ensuring physical comfort, health and physical and mental well-being, such as by maintaining a balanced diet, and an appropriate level of physical activity, keeping warm or cool, avoiding harms to health, following safe sex practices, including using condoms, getting immunizations and regular physical examinations.
       b1442 Retrieval of memory: Specific mental functions of recalling information stored in long-term memory and bringing it into awareness.

5. Goal:                      
The group will:           
       Learn more about aromatherapy and how to use it   
       Experience four different types of essential oils and the effects it has on the body/mind
       Learning how to use natural oils rather than pills to help get rid of pain      
           
6. Who:                      
The people who would most benefit from this treatment session are:
       Those who wish to deal with stress and difficult emotions in an alternative way
       People who have depression, anxiety, and stress can benefit from aromatherapy and can learn about  options other than medication to manage their symptoms.
       Future professionals who are interested in using alternative medicine in their practice of helping others. Also, overall to inform more on the positive benefits of holistic practices.

7. Group size:
The recommended group size for this treatment session would be 1 to 18 people. Aromatherapy can be used on an individual basis or administered to a large group; mainly depends on time allowed during session.
           
8. Materials/equipment needed.
       Aromatherapy handout to fill out experience of each scent
       Diffuser or other method to administer essential oils in a safe manner. In this session the essential oils will be directly applied to the skin and then inhaled.
       At least four different types of essential oils with varying effects and uses to treat different types of emotional problems.
           
1.      Environment:            
Actions/information given:    
       Physical safety addressed by asking if anyone has allergies or issues by inhaling and applying essential oils.            
       Emotional safety addressed by informing everyone that everything said is confidential and will not be said outside of the session. Also, reminding the group to ask questions at any time, especially if they are unsure of what to do. Say the following to facilitate sharing:
I encourage everyone to be open and share as much as they are comfortable.  To get the most out of this experience try to be open with yourself and others. Everything that is said in this group today, will not leave this room.”
1.      Facilitator Tone: Both facilitators will maintain a non-threatening, clear, calming tone. The facilitators will be approachable and open in order to encourage full participation and disclosure.       
2.      Room/Environment: This treatment is best done in an environment indoors, preferably in a closed room to ensure that the scents are not confused with other scents in the air.
3.      Facilitator: Both facilitators will be seated in the circle with group during instructions and sharing. Once aromatherapy is administered, facilitators will go around the group to make sure that everyone is clear on what is going on.        
4.      The above actions will be completed to facilitate an open sharing environment


10. Evidenced Based Practice:

Most of the basic information about aromatherapy that was used in this session came from the National Institutes of Health. This therapy uses essential oils from plants to help balance the body, mind, and soul. There are many types of essential oils that can be used to help sleep, depression, headaches, energize you, calm you, and among other body pains.  These oils are made within the plant cells usually within the leaves, under bark, or peels. When the plants are crushed the scents of their oils comes out.  When these smells are inhaled they can heal the body mentally and physically. The main types of essentials oils used are chamomile, lavender, tree oil, rose oil, and mint. http://www.cancer.gov/cancertopics/pdq/cam/aromatherapy/patient/page2

An article titled Meaning of Aromatherapy massage in mental health (Domingos, Sylvia; Braga, Eliana 2014), demonstrated research that aromatherapy is an effective method for helping emotional stress. The study conducted was at a psychiatric unit in a general hospital and the participants were patients who had personality disorder. The results found that the intervention had success in lowering the patients’ anxiety and improved their ability to cope with their illness.



11. Directed Education:


Content
Time –
Mins
Notes
1.  Logistics  
A.  Taking care of "business"
        i. State the session subject:  Aromatherapy
  ii. 2 learning outcomes written with behavioral objectives:
- Learn the benefits of Aromatherapy
- Learn how to use aromatherapy for emotional stress
    B. Agenda:
Logistics & Safety:
   -Introduce ourselves
1.      Emotional safety is discussed by remind everyone that this is a safe place for sharing and disclosure.
2.      Physical safety is discussed by asking if anyone has allergies to essential oils.
Warm up questions:
-Ask a few questions to warm up before treatment:
1.      Raise your hands if you feel overwhelmed with work, school, personal life?
2.      Raise your hands if you have difficulty managing stress?
3.      Raise your hands if there has ever been a time when smell has triggered a memory or brought some kind of deja vu?
Background
- Inform on some uses of aromatherapy:

1.      Aromatherapy can be used in daily life for the body, mind, and spirit. List some benefits.

           


                                             
5
C: Thank you for coming to our treatment session today. My name is Caitlin
B: And my name is Brittany. We will be treating through Aromatherapy today.







C: We just want to let everyone know that this is challenge by choice. Everything that is said here will not leave this room. Also, if you have any allergies to oils please let us know since you will be applying it to your skin.




B: We have a few questions before starting treatment, please raise your hand if any of these statements apply to you. (Read questions)   















B: Aromatherapy has many uses whether it is for managing emotional health or relieving physical pain such as headaches, joint soreness, has even been used to help patients with their symptoms from cancer. Different essential oils can produce different desired effects. However, multiple essential oils can do similar things such as relieving anxiety or stress.
2.  Treatment with essential oils
   
A.    In following order: Frankincense, Lavender, Rose, Pine.

           Directions:
             -Tell everyone what we will be doing.

              1.  Everyone fills out worksheet under “scent 1” with how they are feeling before treatment when thinking of a stressful situation.

             2. Let them know that after the first scent they need to write down how they are feeling after.

              Application:

             1.  Pass around essential oil and ask that everyone take a little bit and apply it to their wrist and then breathe deeply.
            2. Once 3 minutes have passed, ask everyone to write down on the sheet how they are feeling after.

 (Repeat with each oil)





20 mins.
(5 mins. each, 1 min. for directions 1 min. for filling out sheet.)
         Tell group:
B:  Now we are going to go into our activity. There are 4 essential oils that you are all going to sample today
B: Before we start with the first oil think of something that has stressed you out today
B:Record the feeling on the paper
C:Pass the bottle around and put a small drop on your wrist. Rub the oil in
C:As you are breathing in the smell take notice of what your body is doing
C:Also what are you thinking about when inhaling the scent
(After time is up from inhaling oil)
B:Please record your thoughts and feelings on the paper given to you
Repeat with all the other oils
 B: Second oil- Think of a time when you were really nervous about something or when you had a sleepless night
B: Third oil- Think of a time when you were at a low point in your life and you had trouble being happy
B: Fourth oil- Think of how daily life wears you out and how your body can feel heavy or tired



































After each time the group fills out their sheet tell them which essential oil it was and some benefits.
1.      Benefits of Frankincense:
Very effective sedative that induces a feeling of mental peace, relaxation, and satisfaction, and helps relieve anxiety, anger, and stress.
2. Benefits of Lavender:
Lavender essential oil induces sleep which has made it a common recommendation for an alternative treatment of insomnia. Also treats anxiety, migraines, nervous tension, and emotional stress.
3. Benefits of rose oil:
Natural antidepressant, helps balance hormones, reduces anxiety
4. Benefits of pine oil:
Stimulates the body and mind, and has an energizing effect on the overall person


3.  Discussion

A.    Share thoughts to the whole group
10 mins.
1.      Please share what you thought about the different scents and anything you felt after inhaling them.
2.      Did you notice a difference in feelings or thoughts before and after experiencing the scents?
3.      Did any of the scents trigger memories? 

4. Closure
5 mins.
1.      What did you think about this session and aromatherapy?









Total Time Allotted
40 mins



Aromatherapy Session


Scent 1

Before feelings/memories:



After feelings/memories:




Scent 2

Before feelings/memories:



After feelings/memories:




Scent 3

Before feelings/memories:



After feelings/memories


Scent 4

Before feelings/thoughts:



After feelings/memories: 
_________________________________________________________________________________

PROTOCOL –Treatment Session
By Donald and Stephanie 

1.      Title:   Drama Therapy

2.      Rationale/Justification for facilitating this session:

Drama therapy is the intentional use of drama and/or theater processes to achieve therapeutic goals. Drama therapy is active and experiential. This approach can provide the allow participants to tell their stories, set goals and solve problems, express feelings, or achieve catharsis. Through drama, participants can heal from within through introspection as well as improve their social skills.
3.      Anticipated Outcome:

The anticipated outcome of this treatment session is to have participants achieve catharsis and learn how to problem solve by reliving and acting out an event in their lives.

4.      ICF CODE(s):

The three targeted ICF codes that help to explain the functional change and skill development outcomes of this treatment session are complex interpersonal interactions (d720), confidence (b1266), and insight (b1644).
·         Complex interpersonal interactions (d720): Maintaining and managing interactions with other people, in a contextually and socially appropriate manner, such as by regulating emotions and impulses, controlling verbal and physical aggression, acting independently in social interactions, and acting in accordance with social rules and conventions.
·         Confidence (b1266): Mental functions that produce a personal disposition that is self-assured, bold and assertive, as contrasted to being timid, insecure and self-effacing.
·         Insight (b1644):  Mental functions of awareness and understanding of oneself and one’s behavior.
5.      Goal:

The group will:
·         Learn one technique of drama therapy that they can apply to their own lives.
·          Be able to express their feelings out loud in a verbal manner along with body language.

6.      Who:

The people who would most benefit from this treatment session are:
·         Those who lack skills in the expression of their feelings, assertiveness, and self-confidence.  However, everyone could benefit from learning these techniques to build more successful relationships with others.
·         (Future) Professionals, who work to improve others’ quality of life, would also benefit from learning these techniques to have stronger relationships with their clients as well as developing the skills to better facilitate their clients.

7.      Group size:

The recommended group size for this treatment session would be 10 to 15 people.  The techniques facilitated in this session are organized in a way so that they can be done individually.
8.      Materials/equipment needed.

·         15 red sheets of paper
·         15 green sheets of paper
·         A chair
·         Two printouts of a faceless man and a faceless woman
·         15 small pieces of paper

9.      Environment:

Actions/information given:
·         Physical safety addressed by assuring that if whatever is shared in the session does not leave the room and is confidential.
·         Emotional safety addressed assuring that the participants can choose to participate and stop participating at any point they wish because it is challenge by choice. 
a.         Facilitator Tone:  Non-threatening, clear, calming, light
b.         Room/Environment: This treatment session is best facilitated in a classroom setting with members seated in a circle facing one another. 
c. Facilitator:  will be seated in the circle with group.
d. The above actions will be completed to facilitate an open sharing environment

10.  Evidence Based Practice:

The literature reviewed to create this treatment came from the North American Drama Therapy Association’s online database. This organization has been working alongside professional therapists who specialize in art, music, dance, and poetry since the late 1970s. It establishes credibility and maintains professional standards and ethics for drama therapists (North American Drama Therapy Association, 2015).

11.  Directed Education:

Indigenous Healing Techniques-Treatment Session Plan
Content
Time –
Mins
Notes
1.  Logistics                                                   
2
A.  Taking care of "business"
i.                    State the session subject :  Drama Therapy

ii.Safety issues:
·         Physical safety addressed by assuring all that is shared is confidential.
·         Emotional safety addressed assuring that the participants can choose to participate and stop participating at any point they wish. (Challenge by choice)

iii.Other logistics:  This treatment session is best facilitated in a classroom setting with members seated in a circle facing one another. 

iv.Ensure that questions participants have are allowed throughout.
2.  Grounding Activity
3
A.  Tell group:
·         To write on the small piece of paper, on a scale of 1-10, with 1 being not great all and 10 being pretty great, how they are doing at that exact moment.
·         Afterwards, fold the piece of paper and put it away.
3.  Experiential Learning: Reliving a past event
16
A.  Facilitate reliving past event activity:
1. Prompt participants with the first question, "Have you ever made plans with someone who canceled on you at the last minute?"
2. Follow up with the second question, "How many of you, in that situation, at least once responded to the other person with something that basically meant 'It's okay' or 'Don't worry about it'?"
·         Why did the participants respond this way?
·         When an agreement is made and one person breaks it, is it really okay?
3. Explain to the participants that the red piece of paper is for them to write about what they actually said in that situation in response to the other person while the green card is what they really wanted to say to the person instead. The participants are informed that they will have the choice to share what is on their red card, but will be required to act out the green card to a chair with a faceless person on it (male or female option is provided), representing the person who canceled on them.
4. Facilitators will provide a quick demonstration of the activity.
5. Then, it is the participants' turn to each act out their green cards and/or share their red cards.
4.  Processing

16
A. Ask for a volunteer to start off responding to the prompt.
·         Ask the participants, "What was it like to go through that part of your life again, but this time, doing it the way you wanted to?"
·         Have every participant share, unless they choose not to.
6.  Conclusion
3

a.      Facilitators conclude: Have the participants pull out the piece of paper at the beginning of the session with how they rated how they were feeling prior to the treatment session. Then, have them write down the number they feel they are at after the session. Have them go around sharing these two numbers.
      d.Thank the group and congratulate them for    participating.
Total Time Allotted
40
mins




Reference
North American Drama Therapy Association. (2015). What is drama therapy? Retrieved from             http://www.nadta.org/what-is-drama-therapy.html

_________________________________________________________________________________


Treatment PROTOCOL – Art Therapy
By: Ciarra  and Ben 

1. Title: ‘Happy Mind, Worried Mind’ Art Therapy Treatment Session


 2. Rationale/Justification for facilitating this session: 
Every day, each person will experience stressors, some which will manifest as worries, like failing an exam and some manifest as happiness such as riding a roller coaster. Through tools such as ‘Happy Brain, Worried Brain,’ people can utilize art therapy in order to explore, organize, and express emotions in a positive fashion. By doing so, participants can be more aware of themselves, what they experience on a day to day basis. and more capable of positive expression. 

3. Anticipated Outcome:   The anticipated outcome of this treatment session is to have participants experience exploring their thoughts and feelings, while providing them with a tool to organize and express those feelings in a positive and revealing fashion through art.

4. ICF CODE(s): The three targeted ICF codes that help will support the functional change and skill development outcomes of this treatment session are:

Intellectual Functions (b117): General mental functions, required to understand and constructively integrate the various mental functions, including all cognitive functions and their development over the life span.

Higher-level Cognitive Functions (b164): Specific mental functions especially dependent on the frontal lobes of the brain, including complex goal-directed behaviors such as decision-making, abstract thinking, planning and carrying out plans, mental flexibility, and deciding which behaviors are appropriate under what circumstances; often called executive functions.

Openness to Experience (b1264): Mental functions that produce a personal disposition that is curious, imaginative, inquisitive and experience-seeking, as contrasted to being stagnant, inattentive and emotionally inexpressive.


5. Goal:    The group will:
1.    Learn a basic art therapy technique “Happy brain worried brain”
2.    Learn to explore and understand emotions
3.    Learn how to properly organize and express these emotions in a positive, non-stressing manner.

6. Who:   The people who would most benefit from this treatment session are:
 Those who experience stress, depression, and anxiety in their lives and wish to experience positive change of these symptoms. Additionally, clientele as well as the average person can benefit the holistic effect of not only feeling in touch with one self’s emotions, but also the healthy expression of those feelings in an artistic fashion, rather than experiencing the effects of their emotion as stress and/or anxiety.

7. Group size:   This Art Therapy facilitation is done best in a  group of nine to twelve people, so the therapist have time to allow each participant to share and to really discuss the content.

Our group consisted of eighteen people and took 1 hour and 20 minutes.  If the group size were smaller there would be a similar outcome in less time.  It is important that there is a group larger than six people. Nine participants would be ideal (to guarantee groups of three) for making the posters, sharing posters, and discussing thoughts and feelings with.

 8. Materials/equipment needed:
We used:
Supplies list:
1.    Poster sized paper: for the collages
2.    Pens/coloring pencils (for tracing heads and coloring)
3.    flash lights: to trace heads
4.    tape (glue works as well) for the pictures
5.    a deck of playing cards, for ‘52 card pick up’


9. Environment:
1.    For our art facilitation we made the room more comfortable and user friendly, to do this we focused on the:
a. Facilitator’s Tone: Even, low, light, we laughed and smiled, and spoke at the level of the participants in a manner they would understand and be able to relate to.

b. Lighting: To make the environment relaxing we only used half of the lights in the room.  The room is very large with very bright lighting and white blank walls.  By making the lighting low we took advantage of the sun filtering through the windows making an easy to focus, easy to concentrate, and mellow environment.

c. Room/Environment: The room we were conducting our art therapy session in is located on the second floor, in the corner, with one class room next door.  We closed the doors to allow privacy. In the front center location of the room we assembled eighteen chairs in a circle facing one another.  This allowed our participants to view us and view one another easily.  We also put all the extra chairs near the tables, situated away from the walls, so we could hang the paper for the art project on the walls. In the corner were two tables with all the art supplies, away from the tables where the participants would need privacy to make their own posters.   

d. Facilitator:  Both Ben and Ciarra were positioned in the circle side-by-side.  The Circle allowed the participants to see and hear both facilitators and one another.



10.  Evidenced Based Practice:

There is not enough funding to research Art Therapy as evidence based practice.  Although, evidence based practices (EBP) are uniform by government standards EBP’s have adopted many non-orthodox practices, such as art therapy, because art therapy is effective, has positive results, is commonly practiced, and is widely accepted.

Coiner, Jordan, and Kyung Hee Kim.",by Gilroy, A." Journal of Creativity in Mental Health 6.3 (2011): 249-54. Web.

11. Directed Education:



Content:
Time in minutes:
Comments:
Introduction: Challenge by Choice speech
(done by Ciarra)

followed by:


and attention getter
‘52 card pickup’
(done by Ben)
4 minutes

52 Card pickup:
     Choose two volunteers to ’play a game’
     Say’ This game is 52 card pick up,’ have volunteers pick up cards.
     Compare stack of cards to happy brain, collected thoughts. Compare scattered cards to scattered thoughts or ‘worries.’


Lead in-
(Done by: Ciarra)
1 minutes
Explain: We all have stressors some manifest as worries, like failing an exam and some manifest as happiness such as riding a roller coaster, today we will be exploring our thoughts and feelings through an activity called ‘Happy Brain, Worried Brain’....

Introduce project/show participants how it’s done

(Done by Ciarra and Ben)
2 minutes
     Have group face the front whiteboard
     have pre-taped blank poster ready.
      Using flashlight marker trace partners head (while explaining how project is done)
     Ask group if they have any questions when finished
     break people into groups of three (a tracer, a light holder, an a model)
Participants make their own

Tell the participants they have  ‘13 minutes’
(groups of three)
Show and Tell
15 minutes
Have clients show and tell their posters, this could take longer because the therapists can conduct therapy as we go around the circle.
Closure
5 minutes

Ciarra-closure
     Sit silently for thirty seconds
     Take a deep breath
     ‘In own word tell us what you learned about yourself from this session.’



Directions:

1. Show clients how to trace their heads using a flashlight, a pen, and a large poster paper. We did this in groups of three but it can be demonstrated with two people. 
Three roles:
A model, a tracer, and a flashlight holder (each person switches roles until all three people have their own poster)

2. Write ‘Happy’ on one head and ‘Worried’ on the other. Tell the clients to fill in one side with what makes the happy and the other side with what makes them worry.

3. Ask clients if they have any questions or need clarification.

4. Allow clients to make their own 


_________________________________________________________________________________

 Treatment Session Protocol
By Adriana  and Elsie 

1. Title: Mask Making (Art Therapy)

2.  Rationale and Justification for facilitating this session:
Mask Making is a traditional and expressive form of therapeutic art. The history of mask making dates back to several centuries ago when they were used for rituals and ceremonies. Today, masks are made in different ways and may be used for entertainment, disguise, protection, or ritual practices. Nevertheless, masks in therapy have been used as a tool for clients to reflect their experiences onto. By facilitating a session on outside and inside masks, clients will become more aware of the person people think they are or how they show themselves to others versus who they really are inside.

3. Anticipated Outcome:
The anticipated outcome of this treatment session is to have clients increase their self-awareness and self-acceptance. Clients will be able practice healthy communication by sharing how they are actually feeling, or by exploring issues in a nonverbal manner.

4. ICF CODES:
Two ICF codes, b11420 orientation to self and b1644 insight, were targeted to justify the outcomes and functional change of this treatment session.
       b11420 Orientation to self: mental functions that produce awareness of one's own identity.
       b1644 Insight: Mental functions of awareness and understanding of oneself and one's behavior.

5. Goal
The group will:
       Learn the technique and concepts of mask making.
       Experience the benefits of mask making.
       Learn to accept and show their true identities.
       Gain a new perspective on issues and experiences.
       Express emotions that are difficult to identify and verbalize.

6. Who:
The people who would most benefit from this treatment session are:
       Those who are experiencing grief and loss, trauma, abuse such as sexual or domestic abuse, anxiety, and depression.
       Those who need help revealing themselves and in trying new attitudes and behaviors.
       Those who have difficulty with verbal communication.
       This treatment session, however, is open to anyone because it helps to increase self-understanding and healing.
       Future professionals can further benefit from mask making as well because they can learn to gain a sense of their own different identities that may interfere with treating clients.

7.  Group size:
The recommended group size for this treatment session would be 10 to 16 clients. The treatment session is facilitated in a manner that allows clients to work on the treatment activity individually.

8. Materials and equipment needed:
       16 masks
       16 paper plates
       Tape
       Construction paper
       Markers
       Scissors
       Other art materials (e.g. ribbons, tissue paper, feathers, etc.)
       Laptop and/or speaker for instrumental music
           
9. Environment:
Actions and information given:
       Physical safety will be addressed by making sure the room is set to an appropriate brightness level, to ensure individuals feel comfortable.
       Emotional safety will be addressed by ensuring that the environment is a nonjudgmental and closed-environment:
            “We encourage everyone to share today, but we do remind everyone that this is      challenge by choice, therefore there is no obligation to share. We want everyone to feel comfortable and safe.”
a.       Facilitators' Tone: clear, calm, and inviting.
b.      Room and Environment: This treatment session is best facilitated when clients all sit in chairs and form a circle
c.       Facilitator: The facilitators will also be seated in the circle with the group.
d.      We will facilitate the treatment session through the above actions in order to create an environment that is comfortable enough to foster sharing and learning.

10.  Evidenced Based Practice:

       An Expressive Mask Making for Teens group was created for adolescents with anxiety, and depression, and for those who have gone through trauma, abuse, and loss. Each individual made three masks that would represent their past, present, and future self. Through mask making, the adolescents were not only surprised by their own artistic skills, but they most importantly were able to address the age appropriate developmental task of identity formation.

Brumleve E. (2010). Expressive mask making for teens: Beginning insights. American Art Therapy Association, Inc., 1-3. Retrieved from http://www.arttherapy.org/upload/News&Info/ExpressiveMaskMakingForTeens.pdf

       Mask making has proven to be an alternative method nurses can use in the care of chronically and terminally ill children because it offers those children a chance to heal themselves and acquire control over their environment. In addition, mask making has shown to facilitate a nurse’s ability to attend to the concerns and feelings of the children because a masks reveals a lot about the individual who made it and it allows the nurse to be sensitive to the children’s experiences and cultures.

Driessnack, M. (2004). Remember me: Mask making with chronically and terminally ill children. Holistic Nursing Practice, 18(4), 211-214. Retrieved from http://libaccess.sjlibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2004136809&site=ehost-live

11. Directed Education:

Mask Making - Treatment Session Plan

Content
Time - Minutes
Notes
1. Logistics
1 minute
A. Taking Care of Business

i. State the session subject: Mask Making - A Technique of Art Therapy

ii. Safety issues:
·         Physical Safety will be addressed by making sure the room is set to an appropriate brightness level, to ensure individuals feel comfortable.
·         Emotional Safety will be addressed by ensuring that this is a nonjudgmental, and closed- environment:
    “ We encourage everyone to share today, but we do remind everyone that this is challenge by choice, therefore there is no obligation to share. We want everyone to feel comfortable and safe.”

iii. Other logistics: This treatment is best facilitated when clients all sit in chairs and form a circle.

iv. Ensure that clients are invited to ask questions throughout treatment.
2. Define Mask Making Technique
1-2  minutes
A. Tell group:
·         Attention grabber: Raise your hand if you have ever portrayed yourself as someone you are not?
·         Raise your hand if you have ever hidden your true feelings by acting a different way?

B. Key Concepts and Teachings
·         On a daily basis, people disguise themselves by putting on different masks to protect who they really are or hide what they are feeling.
·         This metaphor comes from the idea of actual mask making which dates back to ancient times.
·         Masks were made for many reasons such as for religious rituals, and today they are also used for entertainment, as a disguise, for protection, and for counseling.  
3. Experiential Learning: Mask Making
1-2 minutes

















15 minutes
A. Facilitate Mask Making
·         Look under your chair, you will find two objects.
·         You will have the option of using the mask or the paper plate.
·         When you have chosen which one you are going to use, we invite you to decorate the outside of the mask or plate in a way that represents the person who people think you are or how you show yourself to others.
·         On the other side of the plate or the inside of the mask, we encourage you to decorate it in a way that shows who you really are or your hidden feelings.
·         Facilitators will provide their own examples on a mask and a paper plate.

B. Activity
·         Clients spread themselves out and begin mask making.
·         Ensure that clients can ask facilitators for help.
·         Facilitators will play relaxing, instrumental music.
4. Debriefing
15 minutes
A. Learning Prompt:
Have the clients go back in a circle.
·         Facilitators will encourage clients to share their outside and inside masks.
·         Facilitators will remind clients that it is up to them to decide how much they are willing to share.
·         Clients may also pass.
5. Closure
5 minutes
A.  Conclusion
·         Before we end treatment, we would like to go around the circle and have everyone share a phrase on what you saw about yourself in the overall process of mask making?
·         What was it like for you?
·         What will you take away from today?

B. Thank the group
·         Facilitators will thank clients for being here today.
Total Time Allotted
40 minutes


_________________________________________________________________________________

Claudia & Mayra
4/27/15

RECL 197: RECREATION THERAPY TREATMENT SESSION
1. Title: Dance/Movement Therapy
2. Rationale/Justification for facilitating this session:  Participants are able to express patterns of thinking and feeling through movement. Encouraging participants to engage in creativity, can further their emotional, cognitive, physical and social integration. Participants are encouraged to express their own feelings with an alternative outlet. Encouraging self-expression relating to our emotions is a tool that is important to use as part of our daily functioning and knowing how to express emotions, creates emotional stability throughout one’s lifespan.
3. Anticipated Outcome(s):  By providing a safe environment, we will encourage self-expression, creative movements and social interaction. Develop and practice strategies that can be used to identify and express one’s own emotions.
4. ICF CODE(s):  
  • d3551 Discussion with many people: Initiating, maintaining, shaping, or terminating and argument or debate with more than one individual.
  • b760 control of voluntary movement functions - functions associated with control over and coordination of voluntary movements.
  • d115 Listening - Using the sense of hearing intentionally to experience auditory stimuli, such as listening to a radio, music or a lecture.
  • d3150 Communicating with - receiving- body gestures -Comprehending the meaning conveyed by facial expressions, hand movements or signs, body postures, and other forms of body language.
5. Goal(s):  
  • By the end of this session, clients will be able to identify different emotions
  • Clients will be able to recognize areas where differentiating self expression in movements can be improved and be able to discuss the topic in pairs and small groups.
  • Clients will learn alternative outlet for emotional expression.
6. Who:
  • Parkinson’s Disease – this facilitation would work well because individuals with Parkinson’s struggle with coordination.
  • Alzheimer’s (Dementia)  – with Dementia, dance movement helps them feel more connected internally or externally, looking for shifts in use of energy and affect.
  • PTSD – with dance movement it is used as the primary means of assessment and communication, the body is not merely addressed in therapy but actually given a voice.
7. Group size:  4-18
8. Materials/equipment needed.
·         Chairs
·         Radio/ speakers for music
9. Environment: Description of the characteristics of the ideal environment.
  • Are there certain actions/information towards which you will pay attention?
    1. We will observe body language and nonverbal communication in response to the music.
  • What will your voice tone be?
    1. Our tone of voice will be calm and professional. We want to keep an open mind and have safety as our number 1 priority.
  • The setup of the room?  The setup of the group?
    1. Open area with chairs in a circle to be used for beginning of treatment. After early discussion, an open area is needed to allow participants to move freely around the room.
  • Where will you be?
    1. We will walk around the classroom as the treatment is going on and check in with participants as well as provide feedback and positive reinforcement.
  • Why will you do it this way?
    1. We will do the things we do during this session to provide safety, awareness, and a positive learning environment as well as provide a sense of ease and comfort so participants can have a better experience.
10. Evidenced based practice.
  • Karkou V, Meekums B. Dance movement therapy for dementia (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD011022. DOI: 10.1002/14651858.CD011022.
11. Directed Education
  •  Logistics:
    • Address safety issues
    • Review basic agenda
    • Set the tone:
    • Provide instructions for the treatment
    • Ask questions
    • Break into a big group where they have their own space to move around, come back into the circle as a big group and share
Facilitate Learning: Setting the tone- How are you feeling today?
a.   Create a Content/Process Spreadsheet –:

Content
Time - Minutes
Notes
Setting the tone
·      Introduce names
·      Safety
·      
0-2
mins
  • Speak with a great enough volume for everyone to hear, while keeping a warm and welcoming tone and smiling warmly
  •  “Welcome to today’s session, I want to thank you for taking the time to attend today and participate in the activities we have for you today. Before we begin I would like to remind everyone that participation is challenge by choice and we do encourage everyone to participate to benefit from the activities we have for you today. If at any time you need assistance, clarification or have questions, please feel free to ask. Either Mayra or I will be glad to help. Also if at any time you feel uncomfortable and feel that you need to step out, that is okay we will check on you.”
Topic : Dance/ Movement Therapy

Movements are able to reflect the pattern of how an individual thinks and feels.

Using Movement and Dance allows individuals to engage creatively to further their emotional, cognitive, physical and social integration.
2-4
mins
1) “Today we’ll be talking about Dance and Movement Therapy.. Where movements are able to reflect the pattern of how an individual thinks and feels.”

Opening question: How are you feeling today?
3-5
mins
“As we begin,
1) I want you to take a few minutes to think about how you’re feeling at this moment. Try to pick an emotion.”
Activity #1
Hand/Body movement expression and mirroring

1)*Facilitators will have participants pair up and provide specific instructions of activity*

2) Participants will switch partners once or twice and express a new emotion with new partner.












5-15 mins

1) “ Now we would like you to pair up with the person directly across from you and thinking of the emotion you picked earlier.

2) You will take turns expressing that emotion in a movement and you will mirror the expression. So while one individual is expressing their emotion either with just a hand or body movement, the other individual will attempt to mirror that movement.”

* SHOW DEMONSTRATION*

Things to say while they are doing activity
1) Keep in mind that you may use your hands or any part of your body.
2) Remember you’re trying to express the emotion you feel right now to your partner.
 -SHARING

1) Bring pairs back into one circle (while standing)


*turn off music prior to sharing if it is playing*
2-3
*Before sharing, have individuals take deep breaths 2-3x*

1) will go around circle and every individual will share the emotion they were expressing and the movement they used.

2) Everyone will do the movement the individual has shared. This will ensure comfort and inclusion.

**follow up questions**

*thank everyone for sharing and state something about why activity was done*

“you were able to experience a different way of expressing your feelings and emotions other than using words and you were able to be creative and attempt to push the envelope by doing something different”

Activity #2
Dance Movement Therapy with Music

*Music will be played after instructions
5-8

1)“ Now we will do an activity that will give you a greater sense of identifying your emotions and expressing your feelings through movement”

2)We will be playing a series of music and you will have the chance to move and express the emotion the music is evoking.

*give demonstration*

1) 3- 4 volunteers enter the circle and will move along with facilitator and music.

2) have entire group move along with the movements the facilitator presents.
       
Things to say as they begin to move   
-so now feel free to roam around the room and try to paint a picture using your body as a whole
-keep in mind how much space you’re using and how it relates to your emotions.
-If you’re having a hard time, maybe start by moving certain body parts and progress to moving your entire body.
-  as you’re moving, feel free to go high, low, be loud, move quick or slow.

MIDDLE OF ACTIVITY
-Check in with yourself, how are you feeling at this moment, pay attention to your breathing….

*Few minutes pass*
- Now pay attention to your space
-- How much space are you taking up?
-- Are you moving aggressive or gentle?
-- If you’re not taking up a lot of space, try it…..
-- You decide if you want to go into the space of others or not
--Make your body heavy now like a feather
→ Individuals will get back into the circle
Process the experience:
3
Go around circle and have everyone share

* What did you notice about yourself?*
àAsk follow up questions when appropriate
Closure:
1) How did it feel to express your emotion in a movement?
2) How does this relate to real life?
3)How can you use this outside of the class?
3
Thank participants


b. Debriefing Questions: List 8-10 questions to help the client process their experiences. See above guide for help.
1.         What did you notice about yourself?
2.         How does this relate to real life?
3.         How can you use this outside of the class?
4.         What is one of the strategies that you can take from this session?
5.         What did you think about today?
6.         How is this helpful to you?    
3.         How did you feel after reevaluating gestures in connection to your feelings?
4.         What did you learn after completing the 1st activity?
5.         What did you learn after completing the 2nd activity?
6.         What does emotions identification mean to you after this session?
7.         Have you identified areas where you would need improvement in recognizing different emotions after this session? What are they?
8. What is one strategy that you can take away about learning to identify which feelings you are having after this session? What is it?
c. Considerations:
  1. We will have music, participants will have to be open minded to portray movements and express how they are feeling through the music
12.  Disembark/Closure
“It is time for our session to end, we hope you have gained a greater understanding on the benefits of dance movement and you can incorporate it in your daily lives”
We ask them these questions:
_________________________________________________________________________________

1. Title: Out with the Old in with the New

2. Rationale/Justification:  This is important because it will help you understand the different ways that we react sometimes and allows us to look back and find alternative healthier choices to our actions.

3. Anticipated Outcome:  After the facilitation you will be  able to have a practical personality profile for yourself and others that can be applied to understanding your good days and bad.

4. ICF CODE(s):
d198 Learning and applying knowledge, other specified
e425 Individual attitudes of acquaintances, peers, colleagues, neighbours and community members
e460 Societal attitudes
e325 Acquaintances, peers, colleagues, neighbours and community members
b11420 Orientation to self
b180 Experience of Self and time functions



5. Goals
-          Clients will became self- aware about their negative/ past habits
-          Clients will  maximize their potential for success
-          Clients will be aware of the negative habits and be able to change them

6. Who:  This can benefit everyone. In a clinical or community setting this can be highly recommended for patients that struggle with the lack of understanding of personal growth including mind, body and spirit.

7. Group size:  The ideal group size would be to 5-20 participants.  It is ideal to have at least five participants in order  to discuss and complete the sharing squares and the concepts of the treatment in order to get the best outcomes.

8. Materials/equipment needed:

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Content
Time-minutes
Logistics:

Shannel “Before we begin I would like everyone to adjust the circle.

*wait until circle is perfect*

Ok thank you everyone, My name is Shannel,

Diana: “And my name is Diana”

Shannel: “And thank you for coming to our treatment session about old ways and new ways.”

Diana: “Just a reminder this exercise is challenge by choice so we highly encourage you to participate, we ask you to try  to be honest and open with yourself in order to get the best experience form from this treatment.

Shannel:  Just a reminder this room is a safe place so anything said during this treatment session cannot leave this room. We ask everyone to respect each other's privacy by keeping everything said here private.”

Set The Tone:

Shannel:  Raise your hand if you ever regretted acting a certain way and wished that you could of done something different.

*Wait until participants raise hands any make some sort of comment like, ‘oh ok, that’s a lot ‘


Diana: now we would like you to think of  specific situations where you wish you could have reacted in a different manner for the best.

we ask you to be honest with yourself and on the left column we ask you to write as many old habits you are trying to improve on that had lead you to a negative outcome. Then on the right column you would write new ways to change those old ways.

 Shannel: ex: on the left column i would add: at work I tend to take charge of my coworkers duties when I know they aren’t doing it the right way.So my new ways is to change that bad habit by letting them fail and then teaching them the right of doing things, that why they can learn from their mistakes.
** look up when you are done**
Diana: Now that everyone is done we will be sharing, as we mentioned before, this is challenge by choice  but we would like to encourage everyone to participate in our sharing squares.

Activity
Shannel: If everyone can stand up and walk to that side of the square. This is called Old ways, New ways grid. One person is going to come onto the  grid one by one. And the goal is to get to  this side of the grid by following the “New Way path”. The participant will step on a square and we will tell you if it is a new way or old way. We have a pre determined path already. After we tell you if the square you step on is a new or old way you will tell us one item on your list.
Here is a hint: if you need help on making a decision on where to go you can ask for help, if needed.

Diana: you will have 10 pieces of paper to place in each square in order to keep track of where you are going to. Once you reach an old way or dead end you will have to go back the same way you came in and collect the pieces of paper, then the next person will try.

**Any Questions?**

Shannel: Thank you all for participating. If we can all regroup and come back to the circle.

  Discussion :
Diana:  If we can take a couple of seconds to collect our thoughts.

Shannel: Now take a deep breath in and deep breath out. We want to hear your experience when you got onto the Old way and New way grid. Did you learn anything about yourself or did this treatment session have any life changing experience.
** with follow up questions**

Diana: If everyone can say one word to describe how you feel now?

Closure:

Shannel:  Thank you all for participating in our treatment. I can tell  that you all had major life changing shifts.

Diana:  now if you are ever in a situation that you reacted a way that you wish you didn't, you have a tool to be aware of it and have a skill to change the bad habit. Remember, the motivation quote is out with the old and in with the new.
0-4 min























2min








5-10 min






















5-10 min












 15mins





12.   Closure –  we hope you all became self- aware or the bad habits that we tend to do and allows us to think or alternative ways to react to certain situations in order to maximize your potential for success.
Closure question:
-           Did you learn anything about yourself or did this treatment session have any life changing experience?
-          If everyone can say one word to describe how you feel now?