2F Young Adult Weekend Programming

Possibilities…By

Alexandra L. Thompson

As employees of Sheppard Pratt, we can help young adult patients properly develop skills in

activities of daily living (ADLs), and instrumental activities of daily living (IADLs). The onset of

mental illness typically occurs between the ages of 13 to 25, which can be a very pivotal time for

most young adults development. Skills such as independence from the family unit, identity

formation, building social relationships, educational pursuits and vocational readiness are common

themes that are lacking among young adults with mental illness (Rouse & Hitch, 2014).

Activity based groups help individuals with mental health practice overcoming challenges,

get involved, and master the occupations that they need to succeed in life (2014). Occupations are

defined as, “doing, being, becoming and belonging”. Doing refers to the engagement of participating

in a meaningful activity; being refers to a sense of purpose in regards to ones physical, social and

mental capabilities; belonging refers to ones sense connectedness to people, places, cultures, and

times in the community; and becoming refers to the personal growth, development and change that

patients experience throughout treatment and their lives.

The young adult patients (aged 18-30 years) that we work with at Sheppard Pratt are

constantly struggling with parental independence, emotional regulation, social skills, motivation, as

well as education and work challenges. Many times, they instinctually isolate because they often

feel like a burden and like no one understands them. Through groups, patients are able to find

hope, universality, and hone their social skills.

This is a list of possible activity suggestions for the weekend groups. They were created to

be both fun and interactive. This list has been made in realization that everyone has different

perspectives and therapeutic talents. Feel free to modify the activities in any way that you see fit to

benefit the patients.

Rouse, J., & Hitch, D. (2014). Occupational therapy led activity based group interventions for young people with mental illness: A literature review. New Zealand Journal Of Occupational Therapy, 61(2), 58-63.

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Table of Contents

Anger Management

Buddha Board Anger Coat of Arms Coping Skills Mad Libs Progressive Muscle Relaxation Pros and Cons for Changing Role Playing Stress Balls Superhero Volcano Wild Invention for Helping you Cope with Anger

Goal Setting

Coat Of Arms Create an Achievements Board: Post Recent Achievements Creating/Designing up Wild Inventions: To help you solve Guess Who Pass The R2D2 Self Help Book S.M.A.R.T. Goals Story Board Visualization Steps of Effective Goal Setting S.W.O.T. Analysis (Mind tools) Wheel of Life (Mind Tools)

Coping

7-Word Spill Beautiful Body Coat of Arms Create Your Own Sensory Room Game Show Introduction: Contestant style Happy Place Picture Pass Make You Own Feel Good Word Search Tissue paper Containment Boxes Peer Role Playing

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Anger Management4

Buddha Board

Materials: Buddha board and waterObjectives: To identify emotions, the early signs of feeling them, effective coping

Activity: Take turns having each member of the group share something that makes them angry. After they share, have them write or paint a word or picture that relates to it on the Buddha Board. Avoid triggering topics for obvious reasons. As the board dries, acknowledge and have a mini discussion about what they wrote or drew.

Potential questions to ask:

How often does this occur? Do you feel the when you are beginning to get angry? What do you do? What are some physical/mental signs that you feel when you start to feel this way? Does anything good ever come from your anger? What are coping skills that you currently use to cope when feeling this way? What are coping skills that you would like to practice to better control these feelings?

As you discuss their anger, the Buddha Board will dry and their angry word or drawing will disappear as you discuss coping skills that help. The symbolism is too ironically ironic to pass up.

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Coat of Arms

Materials: A coat of arms template, drawing supplies

Objectives: To creatively examine the aspects of anger and coping skills.

Activity: Give each patient a blank coat of arms. Have them fill out each quadrant.

Top Left: List 5 warning signs

that you are getting angry

Top Right: Do a drawing of a

symbol/representation of anger Bottom Right: Top 3 things that make you angry (AVIOD triggers) Bottom Left: 5 coping mechanisms that have worked for you

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Mad Libs:

Materials: Mad Lib, parts of speech handout, partners, and markers

Objectives: To acknowledge that dealing with anger can be difficult at times and maybe talk about some coping mechanisms.

Activity: Have group members partner up. Ask them to take turns filling in the various blank words on the Anger Management Mad Lib.

This exercise is fun because it shows the variances and similarities in patient mindsets. This will allow the group leader to positively reinforce good coping skills or identify and suggest different skills that may need attention.

Suggestions: Make sure to Give them a reminder about how to play, what each part of speech is and an example of it, because, we all forget sometimes.

Prompting questions

In what stage can you recognize your anger? (Before it starts, during, or mid-rage) What does anger feel like for you? How do you control your anger? What are coping skills that help?

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Anger

Management/Coping Mad Lib

Sometimes I get so _____________________________ I feel all my inhibition fade

[adjective].

away and I just want to ________________________________. I know I should use

[verb]

distractions and _________________________________________but sometimes I

[verb]

______________________________. After I ______________________________ react,

[verb] [adverb]

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I think about how I could have responded better to that ____________________________

[adjective]

situation. There are times when I feel ________________________________about the way

I

[adverb]

behaved. I understand that it is ____________________________ not to beat myself up

about it,

[adjective]

because change takes time and commitment but, __________________________ it can

be hard!

[interjection]

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Part of speech Meaning Examples

Noun Person, place or thing

trashcan piano downtown George Washington spinach

Verb Action word

run jump fly swim explode

Adjective Description word

large green silly ugly

Plural noun Several people, places, or thingshotdogs computers

Verb past tense Action taking place in the pasthopped rescued

AdverbTake an adjective and stick "ly" on the

end

stupidly quickly happily

Interjection / Exclamation

A short expression of surprise or other emotion

wow ouch hey cowabunga darn it

Progressive Muscle Relaxation

Materials: A quiet room, calming music, and a PMR script.

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Objectives: To gain control of your body and recognize some physical differences between being tense (angry) and relaxed (calm).

Activity: You will need to choose or make a script for this activity. There are several great examples online.

Suggestions: Begin by asking patients about how their bodies feel like when they are getting angry (Tense jaw, clenched fists and forearms?). Talk about healthful breathing and how focusing on each breath and bodily sensations can help with this practice.

Potential Climate Enhancers: If the patients consent, turning the lights off can help focus the mind on the body. Putting on soothing music can help create a serene environment for practice. Do not rush through the script. Allow ample time between each command for relaxation. This could feel long for the narrator but be short for participant.

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Pros and Cons for Change

Materials: DBT Handbook, or a handout that you make.

Objectives: To examine the potential benefits or drawback of change before executing a decision.

Activity: Consider one event in your life that you would like to change. List as many pros and as many cons as you can think of for the change. They can be a simple or complex task but for time and the publicity of sharing with the group, ask them to practice this skill by choosing a change that they would feel comfortable talking about. Give the patients time for introspective thought because this can be challenging.

The DBT Skills Training Handouts and Worksheets book by Marsha Linehan offers several wonderful options for handouts and different formats looking at the advantages and disadvantages of change.

Suggested pages include:

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Chain Analysis/Missing Link: Explanation on pages 20-22, Blank worksheets on page

Wise Mind: Throughout workbook on varying topics

Changing Emotional Responses: Page 227-224 Focus on “Anger” p. 233

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Role Playing

Materials: Individual scenarios for participants

Objective: To practice identifying and use assertive communication to neutralize the potential scenarios.

Activity: Make up different scenarios that might make one angry. Practice playing these parts and having patients use their assertive communication skills. Have the group give feedback on the situations and possible different ways to problem solve or handle the situation.

Suggested themes:

Overbearing parents overstepping boundaries (reading journals, managing their money for them, taking away cell phones or cars, etc.)

Unfair/unhealthy relationships (belittling friends/significant others, friends who always borrow resources without reimbursement, etc)

Working relationships when they must advocate for themselves

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Stress Balls

Materials: Balloons, flour, rice, beans, funnel (can use rolled paper), spoon, unsharpened pencil.

Objective: To create a soothing object to help ease tension

Activity: Talk about anger and the ways that help you cope. Creating a stress ball for patients to use gives tactile feedback, which can be calming in times of distress. They can also act as a good distraction.

Suggestions: There are a few ways to complete this task. Youtube is a great resource. If you use the 2 balloon method, they are usually sturdier.

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Super Heroes

Materials: Art supplies, paper, imagination

Objective: Frame individual traits that we struggle with in a more positive light.

Activity: Each of us has a different reactions/responses to things that make us angry. Here at Sheppard Pratt, we are most likely working on recognizing effective ways to channel our anger, appropriately respond and self-advocate for ourselves. This is a difficult process for everyone. So lets make it fun.

In this activity, ask patients to think about the result of when they get angry and what superpowers they might have. Have them name their superhero self with an empowering name. They can use a combination of their old/new DBT skills to fight crime. Have them draw a picture with crime fighting features.

Suggestion: If someone gets angry and keeps it inside until it burns them up and they feel like they want to explode, they should use that as a superpower. Maybe this person is able to shoot fire from their hands when they get mad. They could call their superself “Feisty Fire Fists”.

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Volcano

Materials: Volcano, 1 tablespoon liquid dishwashing soap, 3 drops red food coloring, 1 cup vinegar, 1 1⁄2 cups warm water, 2 tablespoons baking soda

Objective: Understand and discuss the effects of anger on the body, mind and spirit

Activity: Use the volcano as a symbol for the boiling point. Ask patients to think about a situation that makes them mad and how they handled it. Ask if they think they handled it well, if not what do thy wish they had done differently? As each person shares, give them a portion of the ingredients to put in the volcano (Make sure the baking soda goes last so it does not erupt prematurely). Take the time to discuss these real issues with anger that the patients are facing, the eruption can wait.

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Wild Invention

Materials: Paper, art supplies, imagination

Objective: Identify obstacles, early warning signs, and desired coping skills when facing anger

Activity: Encourage patients to think about the internal and external feelings associated with when they are getting angry about something unreasonable. We all do it. We know we should take space but sometimes, we can’t. Have them tap their inner inventor and create an invention that helps them deal with upsetting scenarios that they could avoid with some help. Upon sharing, therapist could offer similar real life options or alternatives to their creation.

Suggestion: For example, say there was a situation with a sibling. They are being soooooo annoying. Out of habit you are want to hit, yell or be mean to them but that means getting grounded for the weekend. With your trusty “Flying Fancy Feet” invention, you will not get into trouble because they help remove you from bad situations. They are technologically advanced enough to sense when your heart rate has increased past a safe place and fly you to a safe location/happy place.

The therapist may then address how the patient can work on identifying triggers early on, help them plan, and stay out of trouble.

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Goal Setting 20

Coat of Arms: Goal Setting

Materials: A coat of arms template, drawing supplies

Objectives: To creatively examine the aspects of goal setting.

Activity: Give each patient a blank coat of arms. Have them fill out each quadrant.

Top Left: List 3 fundamentals of a good goal. Top Right: Do a drawing or collage of a symbol/representation what goal setting means to you Bottom Right: Top 5 things that goal setting helps you achieve Bottom Left: 5 coping mechanisms that have worked for you

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Create a Personalized Achievements Board

Materials: Magazines, glue, construction paper, markers

Objectives: To identify personal goals that they have or wish to accomplish

Activity: Give the patients a piece of construction paper. Prompt them to think of 9 goals that they have accomplished to collage on an “accomplishments board”: 3 goals that have been the result of positive coping mechanisms (Staying safe, recognizing problem behavior before it starts, eating healthy, taking meds, etc.), 3 accomplished goals that are proud of in their lives and 3 goals that they want to work on in the future. They more creativity, the better!

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Creating/Designing Wild Inventions

Materials: Paper, creative supplies

Objectives: Helps identify they things patients need in order to succeed in goals

Activity: Have patients think about a serious goal/goals that are challenging for them to achieve. Think about the reasons why these goals are difficult. Next, have them create an invention that would help them achieve these goals. Invite patients to share their goals, challenges and creative solutions with the group.

Suggestions: For example, if a patient has intrusive suicidal thoughts that challenges them daily, they could invent a “Thought Challenging Gun”. This invention would allow them to challenge their suicidal thoughts and clearly think their way through. The therapist can then address and discuss alternate methods of challenging thoughts using models such as CBT or DBT.

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Goal Setting Guess Who

Materials: sheet, blank sheet of paper, and markers.

Objective: To encourage and enforce positive self-goal setting.

Activity: Ask patients fill out worksheet about themselves/ their goals. Give them a blank sheet of paper and tell them to number it 1-14 (Or however many participants you have playing). Read everyone’s goal setting sheets aloud and have them write down who they think it is. Remember the order, so you can confirm whose it was at the end to determine a winner.

Suggestion: Be willing to get a prize for the winner.

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Guess Who

Name ________________________________________________

List one long-term goals (LTG)that you would like to achieve in the next year

List three short-term goals that you can work on to achieve your

LTG

List one thing that you can do today to move you closer to

achieving your LTG

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Pass The R2D2

Materials: A stuffed animal or something to pass

Objective: To get peer support for obstacles/topics difficult in patients lives.

Activity: Pass R2D2 around the circle. The person holding R2D2 is the one sharing. They are prompted to speak about an obstacle or topic that they are struggling with in their life.

Suggestions: Go over the group rules first. When no one person is talking, no one else should be; be respectful or your peers; no “war stories”, etc. Then make it clear that when the person holding R2D2 is speaking, no one else should be unless they raise their hand and that person says it is okay. Set a time limit for how long they can share and talk. Have a tissue box nearby. Many common themes will arise. Talk about coping strategies. Encourage group feedback.

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Self-Help Book

Materials: Book cover format page, and art supplies

Objective: To have them examine goals that they would like to overcome in the future

Activity: Prompt the patients, “It is 5 years down the road and you have overcome BIG challenges in your life. In fact, you are doing so well, you decided to write a Self-Help book for people who are struggling with similar life-challenges that you once did. On back of the book cover, write about the three biggest obstacles you have goals to overcome/manage in your life and three coping strategies that you used to get to where you are in your hypothetical today”. On the front cover, have them title their book and design cover art.

Suggestions: You can find a template online by searching “Book Cover Template” or just use a piece of paper folded in half. If you do use a template, turn the page into “Landscape” so they have more room to create and write. Encourage creativity. This is a personal fav of mine.

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S.M.A.R.T. Goals

Materials: Paper, writing utensils, the S.M.A.R.T. Goals poster in the office

Objective: To make specific, measurable, attainable, relevant, and timely goals

Activity: Use the poster in the office. Go through each letter that and what it means. Have them create of their own goals from that format.

Suggestions: Give lots of examples. There are a lot of handouts online that can be used. Try giving them examples of goals that have all but one component missing and ask them to identify which part is missing.

Ex. I will control my anxiety by using deep breathing, distraction skills and coping ahead.

***What is missing?.. The time component. When will this goal be accomplished?

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Story Board Visualization

Materials: Magazines, construction paper, glue, and art supplies

Objective: To think about desired goals to achieve in future

Activity: Ask the patients to think about 5 goals or achievements in life that they would like to work on. Then have them collage those things onto a vision board.

Suggestions: Allow and encourage sharing and discussion at the end. Talk about the steps necessary for achieving these goals.

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Steps of Effective Goal Setting

Materials: Potential handout about the steps you choose for effective goal setting, markers, and paper

Objective: To think about how to effectively set a goal that is a “just right challenge”

Activity: Choose the steps you think are necessary for effective goal setting, discuss, and practice goal-setting skills.

Suggestions: There are many helpful concepts to aid you online. Discuss the “just right challenge”. This concept pertains to modifying tasks so that they are just challenging enough so that the patient can succeed with some effort but not tire and become frustrated. Once the patients have succeeded in the first task, they can grade it up to become more difficult and achieve more. If they are having a hard time, break it down further, so it is less challenging. Often journaling about the process is helpful.

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S.W.O.T. Analysis (Mind tools)

Materials: Handout, & markers

Objective: To o an analysis of your strengths, weaknesses, opportunities, and threats in life and how they may effect your goals

Activity: The S.W.O.T. was originally created by Albert Humphrey in the 1960s as a business tool, but is very helpful in any type of analysis.

Describe what S.W.O.T. is. This is a wonderful tool that can be used to analyzed problem behavior, the pros and cons of making a decision, and helps to prepare for when you are ready to make a change.

Suggestions: https://www.mindtools.com/pages/article/newTMC_05.htm I highly recommend using this webpage as a reference. They have a myriad of wonderful prompting questions.

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Wheel of Life (Mind Tools)

Materials: Wheel of life template, and coloring utensils

Objective: To assess your life and balance it

Activity: It is almost everyone’s goal to live a balanced life. The Wheel of Life helps us visualize just how much time and energy we are spending in certain areas of our life. Most patients have unbalanced life wheels and it might be time to re-balance/re-focus their attentions in a more productive way. The center of the wheel is always 0. Each ring outside of that represents the value of one, however if you are measuring it in time, you can assign a meaning: 1 hour, 1 week, etc.

Suggestions: There are several helpful handouts online. This wheel format is very versatile. It can be measured in many different ways: importance of task, hours per day/week/month focused on these tasks, you can do a current life wheel vs. a life wheel to strive for after prioritizing activities of daily living.

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Balancing My Life Wheel

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Coping Skills36

7-Word Spill

Materials: White board, markers, and paper

Objective: To creatively express oneself and explore the power of words

Activity: Write seven words on the white board that pertain to coping skills. Ask the patients to write a poem/rap/short story about coping using those seven words.

Suggestions: Pick different words that are not super specific. Poems will vary and patients will enjoy hearing each others different spin on using these words. You can do more than seven words if the activity seems too easy. Discussion is encouraged. The power of words are incredibly and can often help people express themselves.

Ex. Coping, anxiety, love, support, blood, happy, and frustrated.

Frustration and anxiety rise,

I feel my blood begin to boil,

My coping skills just aren’t working

Will I ever be able to love myself and be happy?

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Beautiful Body

Materials: Hand outs and art supplies

Objective: To recognize how magnificent you body is and how it helps you cope

Activity: Ask patients about what are some of their favorite coping mechanisms are. Most of them include using some part of your body: Your hands to hold a pen and journal; your ears for listening to music; your mouth for talking, etc. Have them make a color-coded map of the body and write off to the side what these body parts help them with

Suggestions: Share all of these and write them on the board. Other peoples coping mechanisms can provide insight and generate new ideas for others.

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Beautiful Body

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Coat of Arms: Coping

Materials: A coat of arms template, drawing supplies

Objectives: To creatively examine the aspects coping skills.

Activity: Give each patient a blank coat of arms. Have them fill out each quadrant.

Top Left: List 5 of things that cause you stress. Top Right: Do a drawing or collage of a symbol/representation of coping Bottom Right: Top 5 things that coping helps you achieve Bottom Left: 5 coping mechanisms that have worked for you

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Creating Your Own Sensory Room

Materials: Handout and markers

Objective: To have them think about using all of their senses (Vestibular, auditory, visual, tactile, olfactory, and gustatory) and create a personalized sensory room for coping

Activity: Research what vestibular, auditory, visual, tactile, olfactory, and gustatory senses are and be prepared to discuss them and give examples of what each entails. As OTs we learns that when theses senses are stimulated, it can either calm or excite the nervous system. Quite often people are sensory seeking or avoiding. Soothing things help avoiders (Calm music, smooth objects, dark rooms, etc) and excitatory things help seekers (Swings, loud noises, spicy food, etc.).

After teaching the patients about these senses, ask them to design their “Perfect Sensory Room” for when they need help coping. They may draw it or describe it.

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DBT Mindfulness

Materials: DBT Workbook Manual

Objective: To be present in the moment, non-judgmental, and mindful.

Activity: Marsha Linehan’s DBT book offers great insight into treating in a dialectical way. There are many activities and worksheets that help focus patients when addressing certain topics.

McKay, Wood & Brantley also offer insightful mindfulness activities.

Recommended Topics for Coping:

Stone flake On the Lake (Linehan …p.51) Walking down the Spiral Staircase (Linehan…p. 51) Band of Light (McKay, Wood & Brantley… p 69)

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Game Show Introduction: Contestant style

Materials: Handout, markers, the karaoke machine

Objective: To interview each other and think about stressors and coping skills that are used

Activity: Assign partners. Explain that they are going to be interviewing their partners and introducing the “Game Show Style”. Have them use the form

attached to interview and then transform that information into their partners introduction. Using the mic from the karaoke machine is optional.

Suggestions: The more creative and animated the better. Give an example and lighten the mood. Make sure to clap after each introduction. This activity can be used for self-esteem, as well as almost any other group, when the questions are adapted.

“Would everyone please five Mark a warm welcome! Mark is a gentleman who enjoys sport

fishing. He finds sirens, being belittles and his parents stressful at times. He feels his muscles start to

tense, and he goes into a cold sweat. His anger increases and he feels himself start to mentally check

out but he uses his deep breathing, progressive muscle relaxation and if necessary has become quite

good at taking space. He also enjoys distracting himself with reading and exercise. Mark knows that it

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can be tough, but he finds that when he chooses to take space from a stressful situation, he almost

always feels more in control.”

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Name: ________________________________________________

1. One fun fact about yourself

2. Name three things that stress you out?

3. How does your body physically respond?

4. How do you mentally/emotionally respond?

5. What are 5 coping mechanisms that you use when you feel anxiety coming on?

6. What advice would you give peers who face similar challenges when it comes to coping?

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Happy Place Picture Pass

Materials: Construction paper, table tops, art supplies

Objective: To cope and create a happy place

Activity: Have each participant begin with a blank piece of paper in front of him or her. Tell them to imagine their “Happy Place”. Tell them to draw only 1 aspect of their “Happy place” on their piece of paper. Next have them pass the piece of paper to the person on their right. Now, they will each add one feature to the drawing that is being passed. They will continue this cycle of passing and drawing until their original piece of paper returns to them. Then they will share their drawing of their “Happy Place” and why it helps them cope. Others may chime in and state why they added a feature and why it helps them cope.

Suggestions: It is best to preface the fact that they will be passing their pictures and not to get attached. Expect A LOT of beaches and mountains.

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Make You Own Feel Good Word Search

Materials: Graph paper, and writing utensils

Objective: To create a word search they can do if they need to be distracted

Activity: Ask patients to number the bottom of their word search in 2 columns 1-10(15) and think of 10-15 things/factors in their lives that make them happy and help them cope. The words can be anything. Have them use the boxes of the graph paper to keep the words/letters organized. Next write the words into the graph paper. Words may be forward, backward, or on a diagonal. After they have put all the words they want to in, begin filling the word search in with random letters.

Suggestions: Suggest themes like “Coping Skills” or “Things that make me happy when I’m stressed, etc.

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Tissue paper Containment Boxes

Materials: Paper, origami paper, box making instructions, & markers

Objective: To create a containment box for coping items

Activity: Create an origami box. Then discuss he importance of coping. Coping is a very important life skill and can be highly

individualized. Different items and strategies work better for different people. Challenge patients to create an “Effective Coping Box” when they get out. It doesn’t have to be big or have many items in it but it must contain items that are meaningful to the patient. Since many patients have limited access to items while at Sheppard Pratt, instead have them think about and make a lit of items that they can collect upon discharge to help them to cope with challenges they face in the real world.

Suggestions: Suggest items if patients are having a difficult time: A photo of a loved one or pet, a tactile toy, write a playlist of songs that they love, memoirs from a happy trip, etc.

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***Please feel free to modify or add to this binder of ideas. Like I said, everyone has different strengths and therapeutic talents to offer. Collaboration is encouraged, after all, we are a team here at Sheppard!

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