The Effectiveness of Self Awareness...
Transcript of The Effectiveness of Self Awareness...
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The Effectiveness of Self Awareness Training
Kristin Bouma, BA
Case Facilitator, Brain Injury Services
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Outline
Future Plans
One Year Follow Up
Individual Training
Group Therapy Programs
Self Awareness Overview
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What is Self-Awareness?
Accurate perception of skills and abilities
Adult Daily Living Skills
Cognitive Abilities
Social Skills
Emotional Self-Control Skills
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Self-Awareness Deficits
Over-estimation
Under-estimation
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Self-Awareness Deficits Denial of disability as a coping strategy
Impairment of self-perception
Causes conflict and disagreements
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Measuring Self Awareness Levels of Self Awareness Deficits
(Fleming, 1995)
• Awareness of deficits 1
• Awareness of functional implications 2
• Setting realistic goals 3
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Measuring Self-Awareness with the Patient Competency Scales (PCR) • 30 skill rating items
• Self Rating vs. Other Raters
• Four Domains
• Profile of Self Awareness deficits
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Skill Domains
Activities of Daily Living (ADL’s)
Cognitive
Social Emotional
PCR
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PCR Likert Ratings
1 = Can't do
2 = Very difficult to do
3 = Can do with some difficulty
4 = Fairly easy to do
5 = Can do with ease.
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23%
7%
70%
Over-estimators
Under-Estimators
AaccurateEstimators
Incidence of Self Awareness Deficits
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What can be done?
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Self Awareness Interventions
Education to client and family
Planned failure with therapist support
Performance feedback
Videotaped feedback
Prediction of performance
Comparison of client-therapist ratings
Individual/group/family counseling/psychotherapy
Cognitive retraining
Collaborative formation of strengths/weaknesses lists
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Limited Research
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Acute (Hospital)
Sub-acute (Rehab Hosp.)
Early Chronic (1 to 5 years)
Late Chronic (> 5 years)
Research Needed
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Brain Injury Services Research
Two Therapeutic Groups
(2010 and 2011)
Individualized Training
(2011 and 2012)
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Self-Awareness Therapeutic Group
8 sessions
8 to 10 clients
2010 – 18 clients
2011 – 19 clients
Pre and Post testing
PCR
Knowledge Test
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Overall Results – Therapeutic Groups (2010 and 2011)
Knowledge Gains No Self-Awareness Gains
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Individualized Training (2011)
Four clients
One to One training sessions
Videotaped
Predict Perform Evaluate (PPE) tasks
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Procedure
Predict on PCR
Perform while videotaped
Evaluate on PCR
View video, identify errors
Re-evaluate on PCR
Repeat up to 2
viewings
Stop when scores
match
Video
training
session
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Results
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PCR Results
3.7
3.1 3.0
2.9
2.0
2.2
2.4
2.6
2.8
3.0
3.2
3.4
3.6
3.8
4.0
Pre Post
Self
Staff
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Self Awareness Deficits Interview (SADI) Results
5.75
7
5 5
6
4.25 4
1
6 6
0
1
2
3
4
5
6
7
8
9
Mean Pat Grant John Barb
Pre
Post
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Session Results
Highly individualized results
Grant 75% “resolved” after performance only
John 60% of session “resolved “ after video feedback
Pat 60% “resolved” after video feedback
Barb 70% “resolved” after video feedback & find errors
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Individualized Training (2012)
Three clients
One to One training sessions
Videotaped
Predict Perform Evaluate (PPE) tasks
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Results Individualized Training 2012
• 2 trainings terminated for inconsistencies with following protocol
• 1 client completed 10 sessions; however, results of post PCR inconclusive as staff changed at end of training.
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JOHN
Mild Over Estimator
Activities of Daily Living
Participated in both Therapeutic Groups
Difficulties - finances, anger, distorts details in conversation
4.3
3.0 2.9 3.2 3.1 3.2 3.3
3.0 2.7
3.1
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
ADL Cogn Soc Emot Total
Pre - PCR Client Staff
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JOHN – Self Awareness Training Plan
Total: 10 sessions, 10 weeks
Activities of Daily Living (Finances)
Social (Acting Appropriately when around Friends)
Emotional (Controlling Temper)
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GRANT
1.0
2.0
3.0
4.0
5.0
Pre - PCR
Self
Staff #1
Mild Over Estimator Activities of Daily Living,
Cognitive & Overall
Participated in both Therapeutic Groups
Difficulty with school, time management and new learning
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GRANT – Self Awareness Training Plan
Total: 9 sessions, 9 weeks
Activities of Daily Living
Keeping Appointments and Staying Involved in Work Activities
Cognitive
Remembering People, Remembering Daily Schedule, Getting Help When Confused and Understanding New Instructions
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Session Two – Understanding New Instructions • Task: Write two paragraph essay on a social movement.
• Prediction:
• Grant – 3, can do with some difficulty
• Staff – 2, very difficult to do
• Task:
• 1.5 hours spent, wrote two sentences
• Spent 40 minutes on how to double space the lines
• Evaluate:
• Grant – 2
• Staff – 1, can’t do
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BARB
Severe Over Estimator
Activities of Daily Living
Moderate Over Estimator
Cognitive and Overall
Participated in One Therapeutic Group
Difficulty with memory and dressing
1.0
2.0
3.0
4.0
5.0
Pre - PCR
Self
Staff 1
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BARB Self Awareness Training Plan Total: 8 sessions, 8 weeks
Cognitive
Remembering what I had for dinner
Remembering Daily Schedule
Activities of Daily Living (Dressing self)
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Insightful Moments
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One Year Later….
• Grant – Success
• Applied awareness learning to Social Service program at Mohawk College
• John – Success
• Participated in Multi-Trial Training for math and budgeting
• Patrick – Minimal generalization
• Participated in McMaster Multi-Trial training for writing
• Barb – No information available
• No additional programming available
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Grant • September 2011
started Social Services program Mohawk College
• Accurate Estimator in all domains
• SADI score:
• 2011 – 1 out of 9
• 2012 – 0 out of 9
1.0
2.0
3.0
4.0
5.0
2012 Post PCR
Self
Staff
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Summary of Results • Individualized video feedback is an effective
intervention for raising self-awareness • Creates “insightful moments” that may significantly
help in counseling and psychotherapy • Timing is everything • Skill training is a necessary next step • Therapeutic Rapport between staff and client is
essential
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Future Programming
Increase participants
Offer follow-up skill training
Explore functional implications
Overcome feedback avoidance
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Questions?
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THE END?
September 27, 2012
Kristin Bouma