Cohort group Proposal

Group Counseling Proposal: Focus on Depression in Adults with Cerebral Palsy

Kristina Maxam, Jacob Morrow & Kiana Paul

Master of Clinical Mental Health Counseling, Walden University

6250-10: Group Process and Dynamics

Dr. John Yasenchak

April 2, 2023

Rationale

We propose a counseling group serving adults living with Cerebral Palsy (CP). There is a dearth of research on the lived experiences of adults with Cerebral Palsy due to CP being considered largely a pediatric condition (Smith et al., 2019). The group will have an explicit goal of reducing the incidence of depression in participants. A Likert scale questionnaire will be used to collect data, specifically the Patient Health Questionnaire-9 (PHQ-9). The mental health outcomes of the members would be quantified using pre-and post-counseling testing.  

Literature Review

In researching for information on group counseling for adults with Cerebral Palsy (CP), several articles can be found indicating a prevailing need for mental health services for this population. However, the citations are from studies done on children with CP further indicate a need for both research into the mental health conditions of as well as mental health resources for adults with CP.

Statistics

Durkin et al., (2016) states that 1 in 345 people in the United States is diagnosed with Cerebral Palsy. There has been minimal research on mental illness in adults with Cerebral Palsy to date; most research in relation to CP has been on children. The little research that has been done indicates widespread depression and anxiety in adults with CP. Sienko (2018) tells us that individuals with CP are 3-4 times more likely to develop depression than the general population (as cited in McMorris et al, 2021). Subsequently, a 2022 study conducted by Gorter et al., backs up Sienko’s research stating that 33% of the CP population have clinical depression and goes further to tell us that the third most common reason that individuals with CP are hospitalized is mental illness.

Social Engagement

Adults with CP face numerous challenges due to their restricted physical abilities. These restrictions limit the number of social activities they can participate in causing them to have limited social relationships. Social connectedness is a key component to the mental health well-being for all individuals. McMorris et al., (2021) reminds us that limited social engagement can result in loneliness and isolation which are linked to depression. Many people that have CP also have intellectual disabilities creating even more of a struggle with social acceptance.

Family Functioning

Many adults with CP are dependent on their families for day-to-day living assistance, housing, transportation needs, etc. due to their mobility issues. Gorter et al., (2022) conducted a study that resulted in a finding of over 40% of the CP population citing a poorly functioning family as a contributor to their depression. As with social engagement, a positive home/family environment is an important element to mental health well-being.

While there hasn’t been a significant amount of research conducted regarding the mental health of adults with CP, the research that has been conducted indicates a high rate of depression in this population. As a result, there has been limited opportunities for mental health services for this population thus a great need for the group we are proposing.

Group Goals and Objectives

· Group Goal – Reduce the incidence of depression in group participants.

· Objective 1 – Increase social connectedness by utilizing 12 minutes of counseling time in each session for social engagement.

· Objective 2 – Utilize talk therapy to allow members to talk freely about family dynamics and the challenges they face.

Strategies

The leaders of this group will use Cognitive behavioral therapy due to its flexibility and effectiveness.  CBT is intended to influence thinking and the use of mindfulness-based cognitive therapy will assist the group members in being more cognizant of their negative thoughts allowing them to be discarded in lieu of more positive thoughts.  Participants will learn new behaviors to cope with the stressors that lead to depression.  CBT also makes sense for a time limited group such as the one we are proposing.        

Evaluation of Goals and Objectives

Initially, the leaders will reiterate to members the stated goals and objectives of the group. To track the progress of the group members, at week 5 (1/2 way through the group sessions), members will complete a questionnaire about the progress they are making towards the group goals. At the last session (week 10), members will again fill out the questionnaire to see if they believe the goals and objectives were met. Finally, 4 weeks post-group, the members will be sent a questionnaire to see if they are utilizing the skills they gained during the group sessions as well as to ascertain if they have a different opinion about the effectiveness of the group since its conclusion.

Practical Considerations

For our closed group, participants will meet for one hour each week for 10 weeks. Due to the accessibility needs of individuals in the group, our meetings will take place virtually to accommodate all members. To be eligible for the group, the individual must have a documented diagnosis of CP and be seeking mental health support. We will not accept members that have active substance abuse problems, active and current suicidal intent, or psychosis as these issues require immediate treatment. We want all members to have the same opportunity to work toward the goals and objectives without significant distraction or upset.

We will advertise our group through pamphlets distributed at places that work closely with this population, such as medical facilities as well as home healthcare companies. To ensure that members receive maximum support and can participate equally, we propose a group size of 8 members. Informed consent including telehealth standards of practice will need to be reviewed and signed as their acknowledgement of understanding by all members participating in the group.  

Diversity

To serve our target population’s needs we will strive to curate an inclusive environment that honors and is respectful of the diverse lived experience and cultures of our group members. Particularly, when working with adults living with Cerebral Palsy, it is vitally important to curate an inclusive environment in order to hold space for our clients to process experiences that have resulted in depression. Because adults with CP are systemically neglected, we can only rightly seek to cultivate an environment in which people from any cultural background are welcome. We also extend that openness to sexual orientation, gender expression, relationship status, etc.

Termination and Resources

Termination of this group will be especially difficult for its members.  The group leaders must stress to the members at the beginning as well as reiterating throughout that there will only be 10 sessions.  In many cases, this group may be the only social interaction the members have.  It will be important to continually give and receive feedback on the skills learned during the group so the members can practice throughout the 10 weeks outside of the group and retain the skills for when the group ends. 

Additionally, many adults with CP have not had mental health resources readily available thus it will be critical to have counselor referrals for members upon termination of the group.  Being that the group is closed, all issues presented may not be dealt with leaving the members with unresolved concerns they need further counseling for. 

References

Durkin, M. S., Benedict, R. E., Christensen, D., Dubois, L. A., Fitzgerald, R. T., Kirby, R. S., Maenner, M. J., Van Naarden Braun, K., Wingate, M. S., & Yeargin-Allsopp, M. (2016). Prevalence of Cerebral Palsy among 8-Year-Old Children in 2010 and Preliminary Evidence of Trends in Its Relationship to Low Birthweight.  Paediatric and perinatal epidemiology,  30(5), 496–510. https://doi.org/10.1111/ppe.12299

Gorter, J. W., Fehlings, D., Ferro, M. A., Gonzalez, A., Green, A. D., Hopmans, S. N., ... & MyStory Study Group. (2022). Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project.  Journal of Clinical Medicine, 11(11), 3060.

McMorris, C. A., Lake, J., Dobranowski, K., McGarry, C., Lin, E., Wilton, D., Lunsky, Y., & Balogh, R. (2021). Psychiatric disorders in adults with cerebral palsy. Research in developmental disabilities, 111, 103859. https://doi.org/10.1016/j.ridd.2021.103859

Smith, K. J., Peterson, M. D., O’Connell, N. E., Victor, C., Liverani, S., Anokye, N., & Ryan, J. M. (2019). Risk of depression and anxiety in adults with cerebral palsy. JAMA Neurology, 76(3), 294. https://doi.org/10.1001/jamaneurol.2018.4147