Index: L2 / Residential Services for Psychiatric Disability / People with Special Needs / Evaluative study / 17480691
Keywords: Sex education for people with mental handicap / evaluation of group work practice / group effectiveness and efficiency / application of social work values and theories
Abstract: This is the evaluation report of a sex education group conducted by the placement student while on her second placement. The student was placed in a hostel for people with mental handicap. The student has organized her evaluation report into six parts, namely, (1) recruitment; (2) preparation; (3) evaluation of important aspects of the group: program design, members' participation, rules and norms, sense of identity and cohesion, leadership, sub-group and individual changes; (4) application of social work values and theories; (5) evaluating the effectiveness and efficiency of the group; and (6) recommendations.
Duration of the Group: 17th November 1999 to 23rd December 1999
Total Number of Sessions: 12 (twice a week)
Group Size: 8 members (4 males and 4 females)
Members:
Male: KW, KH, CP and CC
Female: KY, KM, FK and PY
Objectives of the Group:
A) To educate the group members on some general knowledge about sex
B) To educate the group members on some appropriate interaction skills
C) To encourage members' interaction and cooperation
D) To provide opportunities for group participants to have recreational and social gatherings
Recruitment:
The worker recruited the members mainly through introducing the group to the target members individually. Most of these members have higher cognitive and expressive ability or have developed inappropriate interaction skills. After the worker's introduction, the majority of them were interested in joining the group.
Also, the worker posted three posters in the hostel's living room. The trainees could sign up their names if they were interested in joining the group. It was found that some of the trainees would ask the worker about the posters and signed up their names.
To conclude, it seemed that the individual recruitment method is more effective in a setting for the mentally handicapped people.
Preparation:
The worker collected information on sex education for the mentally handicapped people through several ways. First, the worker collected the related information through the Internet. Second, the worker conducted library research, through which, the worker found some related books, journals and newspapers. However, it was discovered that the sex information for the mentally handicapped people was not enough in the university's library.
Third, the worker found that there were two organizations, which could provide more related information and materials. Thus the worker applied for the memberships of the reference libraries of both the Family Planning Association of Hong Kong and the Hong Kong Joint Council of Parents of the Mentally Handicapped. From these libraries, the worker borrowed some related materials such as the sex education dolls, teaching guides and videos.
Apart from collecting the related information, the worker prepared the membership cards for the group members.Cartoon stickers were used to mark the member's attendance and signify their obedience to the group rules.
(Comment: The placement worker has been able to look up and utilize the resources in the library and community to help her prepare for the group. It will be helpful for the purpose of this report to build in a stronger evaluative element when discussing the above. For instance, how does the worker evaluate the effort she has put in to prepare herself to practice in an area that she is unfamiliar with? How important does she attach to that? How does she assess the usefulness of both the written as well as resource materials in the light of the members' and her group experience? Has this preparation stage helped her to identify potential issues with regards to working with this client group and on the area of sex education that has helped her to practice better?)
In this group, the worker mainly aimed at educating the members on some basic sex knowledge. The topics included the differentiation of male and female, different parts of the body (include sex organs), comfortable and uncomfortable body touches and how to cope with sexual abuse.
It was found that the members needed several sessions to learn a topic.Also, it is necessary to revise with them the content of the previous sessions.
The worker used games, role-plays, discussions, pictures and videos to run the group.
1.1) Games
As all of the members are moderate or severe mentally handicapped people, it was very difficult for them to concentrate on the group activities for a long time. Moreover, they had difficulties in expressing some complicated ideas (especially on sex education). Thus the worker educated them on the knowledge of sex mainly through games and activities.
It was observed that the members liked to play the games and enjoyed the activities very much. Some of them even gave suggestions to the group activities. During these activities, the worker observed that they could be more attentive during the group. Also, they could understand the sex-related concepts more easily.
1.2)Role-plays
The worker used role-play to educate the members about comfortable and uncomfortable body touches. Also, it was mostly used in educating them on the sexual abuse cases.
It was found that the members showed a lot of interests in the role-play.They participated actively in the role-plays. They could even express more ideas when they were role-playing certain cases or situations.Also, most of the members could attend to the role-plays.
1.3) Discussions
The worker mainly adopted two different forms of discussion in the group: small group discussion and whole group discussion.
During the whole group discussion, it was difficult for the members to discuss with each other actively and formally. They only said something after the worker invited them or asked them some questions. They could only express their ideas in some simple words or sentences in most of the time. Direct interactions amongst the members were few in the whole group discussion.
At the beginning phase of the group, the worker assigned the members into two small discussion groups. At that time, they could not conduct the discussion on their own. From that experience, the worker had learnt that if there was only one worker to lead a group of clients with mental handicap, the use of small group discussion was not effective. (Comment: The placement worker has attempted to articulate her learning from specific practice encounters in this instance. Having said that, perhaps she has somewhat presented her conclusion in a rather crude manner. We can see that from working with this group, the placement worker has (although this was not articulated) learnt about the clients and about the necessary skills in facilitating the group. Firstly, she has derived at a better understanding (or assessment) of the group participants' level of ability or skills to initiate and sustain constructive discussion on their own. Secondly, with this particular group of clients, the group worker realized the need to actively engage and facilitate the clients in both the large and small group discussion in order for the discussion to be helpful and constructive.
In the context of this evaluation on program designs/means, it does come across that the use of games, activities, role-plays, pictures and videos have a better outcome. This can be seen in the group participants' attentiveness, concentration, interest and retention of knowledge. In other words, the use of program means that appeal to more senses such as visual, audio and kinetic are more effective in working with this group of clients.)
1.4) Pictures and Videos
The worker also used many pictures and videos in educating the members. For example, the members were asked to draw out pictures about different parts of the body, different forms of body touch and sexual abuse situations. With the use of pictures, it was easier for the worker to educate on the above topics. Also, the members could recognize and understand these concepts easily.
The worker displayed the sexual abuse situations mainly through a video. It was observed that all members showed interest in that video very much. It was an effective means for the members to learn how to cope with sexual abuse situations.
In the group proposal, the worker had set the target attendance rate to 90% or above. Generally speaking, the attendance rate was 92.7%, which has achieved the set target.
At the beginning phase of the group (session 1 to session 4), the members were quite passive. They did not express their ideas until the worker invited them or asked them questions. The worker assessed that they had little experience of interacting actively with each other. At this phase, some of the members did not pay much attention to the group activities. Instead, they were more interested in the teatime and requested to have food during the group sessions. Also, it was observed that they were only interested in the games and activities.
At the middle phase of the group (session 5 to session 8), some of the members were more aware of their membership and participation in the group. They assembled in the living room on time. When comparing with the beginning phase of the group, the worker observed that they could express their ideas more actively. Although the worker still needed to invite or asked them questions, they were not so shy to express their ideas and views.
During this phase, some of them started to violate the group order. For example, they played amongst themselves and were not attentive to the group activities. Moreover, they were very noisy and disturbed other members. To keep the order of the group, the worker needed to warn or even punish them.
Although they were more familiar with the group and their participation in the group in this phase, they still could not interact with each other actively. However, they had stopped asking for food during the session, as they understood that they would have teatime at the end of each session.
At the latter phase of the group (session 9 to session 12), they could express their wants and ideas actively when compared with the previous sessions. Although they still could not interact with each other well, they showed their concern to each other and talked with each other in a more active way. To encourage their interaction, the worker assigned them to invite another member to do a role-play in this phase. Some of the passive members could then participate more actively in the group.
During the first session, the worker set up three group rules with the members together. They could get one cartoon sticker for their compliance on each rule. If they violated these rules, they could not get the stickers. At the end of the group, the worker would count the numbers of the sticker that they got and rewarded them accordingly. So it was a form of "token economy" in the group. By which, the worker could evaluate if the members had followed the group rules.
3.1) Assemble On Time
The first group rule requested the members to assemble in the living room on time. At first, they were not very aware of their participation in the group very much. After being reminded by the worker and staff, most of them could assemble on time. Although most of them could comply with this group rule in the subsequent sessions, certain members showed their unwillingness to join the group. The worker respected their choice. However, the worker requested that they informed the worker of their absence in advance.
3.2) Attentive to the Worker's Speech
At the beginning phase, many of the members were not attentive to the group activities very much. Only several members could pay attention to the worker when she talked. As the group progressed, it was observed that most of them could participate actively in the group and pay attention to the worker. Only a few of them could not follow this group rule and were thus not allowed to get the stickers. If the members violated the group order to a great extent, they would have a time out and be disallowed to join the activities. They might not be allowed to have food and drinks during the teatime if they violated the rules severely.
3.3) Attentive to other Members's Speech
At the beginning, it seemed that some of the members did not pay attention to other members very much when they were talking. As the group progressed, they learned to clap after others had spoken. This was a great improvement.
(Comment: In addition to identifying the change in the behaviour of the group members, it will be important for the placement worker to reflect on why that happen and how that happen. What has the worker done that may have contributed to the change in members' participation? What has the members done that may have contributed to the change? What are the factors that can be used to explain the change? Given the time constrain of placement, the end results may not always be an adequate measures of one's practice or learning from practice. Therefore, in evaluating one's practice, the emphasis on process evaluation is equally, if not more, emphasized.)
4.1) Group identity
Generally speaking, the worker believed that the members had developed a sense of group identity. For example, most of them could assemble in the living room on time. Even when the group had ended, they still asked to have group sessions. This showed that they strongly perceived themselves as the group members. Also, some of them had actively given suggestions on the group contents and activities.
4.2) Group Cohesion
At the latter phase of the group, the worker noticed the group cohesion amongst the members. For example, they asked why certain members did not come to the group. Also, some of them would invite others to actively participate in the group. Moreover, all the members actively clapped for others in the group too.
KW and KY acted as the leaders in the group. Most of the time, they advised other members to keep quiet and drew their attention to the group activities. To a great extent, they helped the worker to keep the group order. (Comment: How did the other group members feel about KW and KY assuming those roles?)
When the worker had to leave the members alone in the activity room, the worker would invite some of them to take the leader role. They were responsible for keeping the group order. The worker had also invited some "trouble makers" to take the leader role. It was found that the order of the group could be kept quite well.
Since FK and KH were good friends, they liked to sit next to each other in the group. Occasionally, they talked and played with each other during the group sessions and formed a sub-group, which seriously affected the order of the group. To deal with this sub-group, the worker separated them indirectly. For example, the worker assigned them to join different small groups during games or activities. It was found that this could reduce their direct interaction to a certain extent.
7.1) KW
Generally speaking, KW was an active member in the group and he helped to keep the group order. He actively participated in the group activities and expressed his ideas. It was found that he could have a better understanding about sex knowledge that had been taught in the group. When the worker asked the members some questions, he was the first member who responded and gave the correct answer. Also, he had actively given some suggestions on the group contents and activities.
7.2) KY
Like KW, KY was also an active member in the group. She advised other members to keep quiet and drew their attention to the group. She encouraged other members to participate actively in the group. She also had a better understanding on the sex knowledge when compared to other members. The worker observed that she was very attentive in the group.
7.3) KM
At the beginning phase of the group, KM was not very attentive to the group. She repeatedly asked to have food during the group sessions. When the worker asked her questions, she could not respond to them well.
She improved in the later part of the group. She did not ask for food during the sessions anymore. Moreover, she expressed her ideas and views occasionally. She could even invite other members to role-play. It seemed that she could not understand the taught sex knowledge very much.
7.4) CP
Like KM, CP also liked to ask for food and drinks during the sessions. As the group progressed, he learnt that the teatime was the end of each session. Generally speaking, he was not very attentive to the group activities. Moreover, he always looked tired. He violated the group rules occasionally and was punished by the worker. For example, he could not stop jumping even the worker had asked him not to do so. He was then not allowed to play the game. Moreover, he was asked to stay away from the group in that session. Furthermore, he could not respond to the worker's questions on his own and would follow other members' suggestions most of the time.
7.5) KH
In the third session, there was a quarrel between KH and CC. The worker tried to resolve their conflicts. However, after that session, KH was not willing to join the group. After the worker talked to him individually and invited him back to the group, he was willing to join the group again. At first, the worker thought that his unwillingness might be due to his conflict with CC. As the group progressed, the worker found that KH had a tendency to show his unwillingness to participate in all activities. (Comment: Does the placement worker have a sense of why KH has a tendency to behave in this manner?) As the worker could not force KH to join the group, the worker asked him to inform the worker about his absence in advance.
As mentioned before, he formed a sub-group with FK and this affected the order of the group very much. After the worker's "special arrangements", he could not interact with FK directly. Moreover, the worker observed that KH was quite shy to express his ideas or views in the group.
7.6) FK
FK was a member who could not express her views verbally. Instead, she could use her body language, which was easy for others to understand. Her body language showed that she had a good understanding of the taught sex knowledge. As she formed a sub-group with KH, she was also not very attentive to the group activities and this affected her participation. She did not actively express her ideas in the group.
7.7) CC
CC was one of the members who were not very attentive to the group activities. During the sessions, he spoke some impolite words or touched others occasionally. He apologised to other members after the worker advised him to do so. At the latter phase of the group, he was more attentive during the group sessions.
7.8) PY
PY was a member who could not speak Cantonese well. Generally speaking, she did not actively participate in the group. In most of the time, the worker had to invite her to say something or participate in some activities. Although she could not speak good Cantonese, she showed her understanding of the taught sex knowledge through simple words. Moreover, she helped to distribute the food and drinks to other members in each session.
When the worker was leading the group, several social work values had been adopted.
First, the worker respected the members' autonomy and self-direction. The worker did not force them to do anything that they were unwilling to do. For example, the worker did not force KH to join the group when he showed his unwillingness to do it. Also, all members are given chances to give their suggestions in the group.
Second, the worker respected the worth and dignity of each member. Although some of the members badly affected the order of the group, the worker still respected their worth and dignity as a person. So, the worker tried to gently encourage them to attend to the group first.
(Comment: It is interesting to see how the placement worker is evaluating her practice. The placement worker has a view of her practice as giving emphasis to members' autonomy and self-direction. However, from the records of her practice sessions, member's autonomy and self-direction are not dominant aspects of the group process, neither is the adopted approach by the placement worker. On the contrary, the recordings reflected a high degree of 'worker-directed' practice and worker's control over the group. [Look up the ongoing commentary offered in the recordings.] Often, such differences in perception or assessment of how the placement worker has worked in the group exist. This can be between the placement worker and the fieldwork supervisor, between two practitioners, etc. This is why it is important to dialogue across different views and evaluation so as to be more aware and critical of one's practice and the theoretical/practice concepts one is engaging in. Similarly, in evaluation, it is important to gather the members' views of their group experience, apart from the worker's observation and documentation of the group experience.
Returning to this case, the placement worker has given an example to support her point about respecting client's autonomy, that is, she has not forced a member to join the group when he is unwilling to. By doing so, it gives the reader (or the fieldwork supervisor) an idea of how the placement worker is evaluating and linking concepts and practice. From there, she can then be helped to develop greater depth in examining the practice concepts (such as members' autonomy and self-direction) she is building into her practice.)
2.1) Behavioural Modification Approach
The worker mainly applied the Behavioural Modification Approach in this group. It had formed a token economy in rewarding and punishing the members. If they obeyed the group rules in each session, they would be rewarded a cartoon sticker for each rule they had obeyed. If they did not follow the group rules, they would not get the stickers from the worker. At the end of the group, they could get a present according to the number of stickers that they had. It was found that the "sticker system" could help the members to comply with the group orders to a certain extent.
The worker also rewarded or punished the members if it was necessary. (Comment: How was this decided upon? What was the impact on the members, the group and the worker when rewards or punishments are used? For instance, when a member changes his/her 'undesirable' behaviour to another that is 'more acceptable' in the group, what has actually taken place? How the change is experienced or evaluated from that particular member's / other members' standpoint / worker's standpoint (which is articulated here)? At yet another level, the worker appears to be the main person in deciding on what constitutes desirable and undesirable behaviours. Are there issues with regards to this apparently powerful position that the worker has? It will be good for the placement worker to build into her evaluation a power analysis dimension?) For example, as CC spoke some impolite words in the group, he was not given food in that session. Also, CP was not allowed to play the game as he continued to jump up and down after the worker had asked him to stop doing so for several times. This was also a technique of "time-out" and he needed to stay away from the group. (Comment: The "time-out" technique is effective when the client is keen on participating in the activity. In this case, the placement worker had gotten CP to behave in an acceptable manner because he was keen to get back into the game.)
2.2) The Systems Theory
It was believed that the members are like different systems and they affect each other in the group. Thus the worker adopted the Systems Theory to keep the group order and encourage the members' participation. For example, the worker invited other members to give comments on KH's touching behaviour. This could help KH to understand that touching other people's thigh was wrong. Moreover, the members were asked to invite other members to participate in role-playing. This was a means to encourage the members to participate and interact.
The worker will assess the effectiveness of the group according to the proposed group objectives.
1.1) To educate the group members some general knowledge about sex
In the group, the worker educated the members about how to differentiate between male and female, different parts of the body (include sex organs), comfortable and uncomfortable body touches and how to deal with sexual abuse situations.
Generally speaking, most of the members could understand this knowledge quite well. It could be seen in the competition that was held in the last session. During the competition, all members could answer the questions correctly.
Furthermore, there were tests (same test content) for the members before and after they joined the group, in which the worker tested their sex knowledge with some pictures. It mainly tested their ability to differentiate between male and female, the clothes for male and female and different forms of body touch. The pre-group test result showed that 81.25% of the answers are correct, whereas the post-group test result was 89.58%. This demonstrated that the members' sex knowledge had improved.
1.2) To educate the group members on some appropriate interaction skills
The worker had educated the members on some appropriate interaction skills and different forms of body touch. At the end of the group, most of them could understand that touching others' private parts and hips were wrong. Moreover, they recognize that shaking hands is an appropriate interaction behaviour. (Comment: The appropriateness or inappropriateness of body touch needs to be put in context. For this particular group of clients, the challenge for the worker is not just to stop at identifying right or wrong behaviours. As discussed in her group proposal, `The Scarborough Method begins with a specific concept and moves outward in complexity as far as the individual can go'. In other words, for some group members, this may mean helping them to take into consideration the context in which the behaviour was carried out when deciding whether a particular behaviour such as touching another person's hip is right or wrong. Seen in this light, the evaluation of the objective to 'educate' the group members needs to reflect worker's assessment of individual differences and learning as well. In evaluation, the placement worker's analysis appears to have adopted an overly simplified view of this objective or perhaps set it in a way that predetermined what the group participants should know (or learn regardless of their starting point) or how they should act with regards to their sexual behaviours. There is little discussion of worker's understanding of where the group members are coming from; of the varying individual ability to see body touch or physical intimacy as normal in some relationships; of their needs for intimate relationships, etc. This could have also been discussed in the discussion of change in the individual members in the earlier section.)
1.3) Encourage members' interaction and cooperation
The worker had set the objective that the members interact with each other at least twice in each session. At the beginning of the group, it was difficult for the members to actively interact with each other. Thus this objective was not achieved at that stage.
As the group progressed, the worker encouraged mutual interactions among them and the objective was achieved. However, it seemed that, without the encouragement of the worker, they did not actively interact with each other.
1.4) Provide certain levels of recreation and chance to join social gatherings
There were many games and activities in the group and it seemed that the members enjoyed them very much. Moreover, there was teatime in each session too.
(Comment: As commented in the group proposal, the third and fourth objectives are essentially generic to group work and need not be single out as group objectives unless the student has specific reasons for doing so.)
The worker believed that she could utilize the community resources well. For example, the worker had borrowed the sex-related materials from several organizations.
The worker learnt from this experience that it would be better to have a smaller group size. Group members can get more attention from the worker if the number can be reduced to four. They can have more opportunities to participate in the group too. The most important point is that it will be easier for the worker to keep the order of the group.
It was observed that the members could not attend to the group for a long time. It would be better for the group session to last for only 30 minutes. If the duration needs to be longer, it is better to have a break for the members.
It was observed that the members paid more attention to the group when games or activities were used. So, it would be better to educate them on sex knowledge with these means.
|
Income |
Expenditure |
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Agency's Soubsidy $569.1 |
Food for session 1 to 11 $221.9 |
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Food for the party $61.7 |
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Gifts for the party $118 |
|
|
Rental for the sex education materials $50 |
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|
Photos $81 |
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Other expenses $36.5 |
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Total: $569.1 |
Total: $569.1 |
(Comment: References need to be included.)
Written and revised by: 17480691 (Student)
Instructor: Mary Cheung
Copy Edited by: Phyllis Chee
Commented by: Phyllis Chee
Copyright © 2001 by the City University of Hong Kong. All rights reserved.