83: Group or Individual Nature-Based Therapy? - Considerations for Choosing the Right Model of Service Delivery
===
[00:00:00] Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always a hundred percent real. You'll hear it all on this podcast. Dr. Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at therapyinthegreatoutdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in.
Hi, everyone. Welcome back to therapy in the [00:01:00] great outdoors today. I want to talk about group versus individual nature-based therapy services. So this is a question that comes up a lot in. My consultation and conversations with people in the nature-based space. And in my own practice, we have had some questions about this recently because there are a lot of complex situations that come up when you are providing therapy for children.
So I will share. Some things that inform how we make decisions in my practice and what I recommend other practices to do. Based on the learning I have had over the last, almost 10 years now of running my nature-based practice.
So we're going to talk about the goals. Of group versus individual. The focus of group versus individual, some key questions to ask yourself when deciding group versus individual and also some [00:02:00] caveats for each of these service delivery models. So let's dive right in. Okay. So my practice offers mostly groups.
That is how I started my practice. And we developed all the systems around our groups. The Contigo approach that I developed to nature-based therapy was primarily designed thinking about a group service delivery model. You absolutely can use the Contigo approach with individual services as well. But I say all this to let you know, kind of the background and the experience I. Come to this conversation with so. I'm going to start with talking about groups because that is what my bread and butter is in a way. So. When you think about the goals of the child that you are thinking about putting into a service. Groups are excellent for social interaction and [00:03:00] motor goals.
So while some motor goals. I'll give some examples here. So groups are really great for kids who need to work on. Social emotional skills. Who are ready for that? Next level of service that happens usually after a period of individual service delivery. So kids in a group need to be able to deal with the complexity of the groups.
That is one of the key questions to ask is can the child handle the complexity of a group therapy model? Because there is a lot going on in a group therapy model. That just does not exist in a individual service where you can cater everything directly to that child. So the goals for children in a group are typically social, emotional goals and motor goals.
Now I will say something about the motor goals. If you have a child who needs [00:04:00] very specific like I'm thinking a kid maybe with cerebral palsy or something who needs some manual therapy or hands on therapy, obviously. That might be better delivered in an individual treatment session where you can individualize what you're doing for that child. But those tend to be the goals for groups are social interaction, social, emotional regulation, and motor skills.
The key thing to consider with groups is that the focus. Of the group. Is on. The entire group. It is not on that one individual child. This is something that is very hard for Americans to understand, because independence is like in our blood, right? Like it's very hard for American parents, American children, American therapist. To wrap our brains around this concept of the group being more important than the individual. [00:05:00] We live in a culture here in America.
That is. It's just, it's like what I said, it's ingrained into us in childhood that we should be independent, not inter dependent. And I would be so interested to hear, I may have said this before on the podcast, but I would be so interested to hear if any of you are listening and you come from a more Eastern culture. Where interdependence is more normative and considered the norm.
Right. I'd be interested to hear if you have thoughts on this, because I, really feel like it is something that is hard for Americans to understand, but.
The group. Needs need to supersede the needs of any one individual child in that group. And the hard thing is that what this means is that sometimes you, as the therapist might have to have that hard conversation with families after. A whole plan is [00:06:00] put in place and you go through a, system in your business for managing the behaviors in a group. But you may have to go to the. Extreme measure of asking a family to leave a group.
If the child is not a good fit for that group. At that point in time, I always encourage therapists to use the words. Not yet with families. Meaning, it's not a no. Not ever, never, never. It's the child is not yet ready for a group. Service delivery model. And sometimes it's not even that they're not ready for a group.
It's just that they're not ready for this particular group. Because that is one of the things to consider about. Group therapy. And these are the caveats here.
It is complex to offer a group because of all the logistics involved, you have to really consider the needs of every single kid in that group. And think about as the therapist, [00:07:00] whether those children together will make a good group for service delivery to address the goals of each child in that group.
So there's a real art and a skill to doing this. We have developed loads of systems around this, in my business over the years. And sometimes we still make mistakes. Sometimes there are still, I would say over the course of 10 years of running my practice or nine and a half now, I guess like, I would say we've probably only had to, to really like ask a child to leave a group or place them in a different group. Three to five times, maybe if I'm remembering right. so it's, it's very infrequent, but it does happen and you have to be willing to make sure that the needs of the group supersede the needs of the individual at that, at that time, your, your goal as a therapist is to make sure the group is a positive experience for everyone involved. So the, complexity of offering groups is hard also from a business perspective, because you have to [00:08:00] have. Three to five people that are interested in attending that group at that specific time, at that specific place with kids who have the needs that matched together to make a good group. And you have to have. An influx of a lot of people in order to find the good match for the group.
So with individual services, you know, one person applies, you can accept them. There's no kind of vetting or needing to match them to certain other people's needs and to the time and place and all of that. Well, I guess time and place, but not to the needs of other kids that would be in the session because an individual service is just the kid.
Right? You can individualize it. But with the group. You might need. 12 people to apply in order to find for that are a good fit in a group. In that certain age range. That's the other thing, age range is the other thing with groups that you have to consider. So. I, this is [00:09:00] not an exhaustive list of all the things you need to consider when you're planning a therapy group.
But I hope the bit of information I've given here has given you context to understand the complexity of running a group. And all of the thoughtfulness that needs to go into your systems and the business on the backend in order to do that effectively to serve families and children really well in a group. The other caveat with group services. Is that. There is less direct time for therapist providing the in-person treatment. So in some ways this can be. A benefit for therapists because when you hire people, you can encourage them that much of the work that they're going to be doing.
Like they're at admin work, you know, the documentation and the planning for services. That can be done on their own schedule whenever they prefer in the, in the comfort of their own home or at a coffee shop or wherever they prefer to work. So there's a little bit of [00:10:00] flexibility there for the therapist that you might hire in your business because you can provide service in maybe two hours to. Five different kids, maybe even six, if you have good staffing, right. Oh, another thing I didn't mention is the complexity of groups is that you need help to run the group.
Right? I would never ever say a therapist should run a group by themselves in the woods or even in a public park with kids. It's just not safe to do so. You need a volunteer or another parent or a student or a paid group, assistant someone who is helping you with those services. So that's another logistic of groups that makes it challenging to offer a group compared to an individual service.
And I'll talk about individual in a bit. Okay. And the last thing I want to say about groups. Is that you need to have very, very crystal clear policies in your business. In order to. Help parents understand that concept [00:11:00] of the group needs superseding the needs of any individual child. So I am not going to share my full behavior policy for our groups, because that is something that I share in my paid programs.
And I'm always. Thinking about the people in my paid programs and making sure that when I am sharing things publicly for free, that I am honoring that some people have paid for this information. And so I don't go into great detail on the podcast and give away everything that I have, because I want to honor that people in my programs have paid for these things.
So I'm not going to read you my whole behavior policy. For therapy groups and camps. But what I am going to tell you is the gist of what you need to include, and then you can come up with your own policy.
This is one of the benefits of being in my business coaching program that I give all my policies to the people in that program so they can just take my policy and edit, put their business name, put little, you know, edits as they need, rather than [00:12:00] coming up with the whole policy. But, here are some things that you need to consider In your behavior policy for groups, so you want to talk about your staffing ratio, how many staff do you have for how many children, and make it really clear that their child needs to be able to operate with, with that level of support.
You also want to talk about your behavior policy, like what is your policy if there are behaviors that repeatedly disrupt the experience of the other kids in the group. and you want to be very explicit about, the exact behaviors that children need to have in order to be able to attend the group.
So like staying within eyesight of the group without an adult. holding them, right? So things like that there's several that we list out in our policy, but you need to think about very specific behaviors so that it's very clear to families. So families could read the list of things that you expect children to be able to do to be in a therapy [00:13:00] group in your practice and say, Oh no, my child would not be able to do that.
Or yes, they could do that. I think this will be fine. So. Focus on safety. Talk with families in your behavior policy about the importance of them answering honestly and signing the policy and agreeing to it honestly, because it is extremely important for their child's safety in the group. And I don't think we can overemphasize the need.
The number one priority in your groups is to keep kids safe. All right. Working on goals is the second, second thing that you need to do, but they have to be safe, right. In order to work on their goals and in order for you to provide an effective therapy service.
Okay. So very clear policies for group is very important. Let's move on to talking about individual. Now. Individual services, really the goals can be anything that you want to work on with a child, but I [00:14:00] will say that working on social skills in an individual session can feel a little contrived or artificial when it's an adult to child model, right?
Or an adult and child model. So the goals that are great for individual services are those type of goals, which I kind of mentioned when I talked about group, that require you as the therapist to do some very specific teaching or very specific manual skill or very specific monitoring of the child's response to a certain thing that you need to do in your therapy session.
So if the child requires one on one attention from the therapist in order to reach their specific therapy goals, you probably should have the child in a one to one service. That's the key question. Does the child require one on one from the therapist in order to reach their therapy [00:15:00] goals?
And if the answer to that question is yes, then you need to have them in an individual service. Group therapy is probably not the best place for them if they require a lot of support from the therapist.
So an example of a therapy goal that a child may be an individual service for is something like handwriting. It is challenging in a group model to get kids to do enough of the repetition that you need in order to teach a motor skill like handwriting. What we need when we are teaching any motor skill really is repetition.
We need those pathways to be laid down in the brain. We need the child to be able to learn those so that they're made automatic, right? And that's really challenging to do in a group setting. Now, I guess probably you could do maybe a handwriting, nature based therapy handwriting group or something like that.
But I do think that a lot of skills that require the motor [00:16:00] skills that require that automatic response. I think of speech therapists here where you're trying to get a child to produce a sound automatically on their own when you're not around and you need that repetition over and over and over and over.
That might be best for a one on one. service delivery model because you can track those repetitions and you can actually allow the child to get a lot of repetitions versus in a group setting where they might only get one of every four or five repetitions if there's four or five other kids there. Okay, so those are the goals that are best served in individual.
One more thing I may say here is that sometimes a child does need one on one work on emotional regulation. in an individualized way in which that therapist needs time alone with that child in order to kind of help the child with some of their own strategies or their own, [00:17:00] learning their own body in a more private way, in order to help them be able to self regulate in a group setting
and have that emotional regulation in a group setting or practice those strategies in a group setting. So individual is obviously needed when kids need individualization of their therapy, activities and to work on their therapy goals. With individual services, the focus is the individual skills for that child.
I kind of already said that. The caveats here. Well, one caveat is that it is, I don't know if this is a caveat, I think of a caveat as something that is like, but, Also consider this, you know, but really individual services are very easy to set up and provide again, because everything is individualized with that family.
So you don't need to consider the needs of like the four other families that are in the group or whatever. You can just make that [00:18:00] program or that service for that child at a time that works for that family. And then. And then start the services, right? So it's fairly, fairly simple. I didn't really talk about assessment when I spoke about groups.
We do do an assessment for children that enter our groups, but it's kind of a mini quick assessment. It's a, it's a low complexity OT assessment that we do. And in the individual model, we can do a high complexity assessment. We can do multiple standardized assessments. We can do a big write up of a report.
We do not do that for our group. So that's something with individual, again, that you give a person a more individualized level of service in an individual service model. So some other caveats, that I have to say about individual services. I feel very strongly that parents should stay for an individual therapy service for their child, because some of the best treatment models for [00:19:00] at least an OT I can't say that I know the research for, maybe speech therapy and PT, but for mental health therapists and occupational therapists, play therapists, social workers, for those of us working on any kind of social emotional regulation with children and their mental health, like anxiety, depression, those types of, diagnoses for any of us working on those types of things with children, social emotional skills.
Parents are the key people that need to be in that session. And the research indicates that when parents are involved in the session, and when we use a parent coaching model, where we are actually looking at the parent as our client, along with the child, we get way better outcomes. And so the research is very clear on that.
I just finished reading. A book which is controversial and by a controversial author. So please do not cancel me or come after me [00:20:00] for saying this book on the podcast, but I highly recommend that people read it and at least consider what she is saying. It's called Bad Therapy by Abigail Schreier. And She talks in this book she's specifically speaking about children and treatment for mental health through most of the book, and she gets into kind of children and adolescence too.
But I think most of us that are listening to this podcast probably work with the like under 13 age range. So I just want to say that. She writes about how much of what we do in treating mental health with young children is actually not evidence based and is not supported by evidence. And she will share some research in that book that is going to be, I'm sure, shocking to you if you are a pediatric therapist like me.
Because a lot of the things that we hold As like absolute truths in our practice, she actually brings up evidence that kind of states the exact opposite. So we're actually doing a book club kind of [00:21:00] study on this and my business coaching program, because it's, such a good read and so provocative and I think it will be really great for conversation for all of us to, , to talk about in our work.
I might actually open it to, Contigo therapists as well and maybe even to the therapy in the great outdoors community. I'll have to think about that because I haven't scheduled the date yet for when we're going to do that book club, but it's just, it's like very, very low key, but we decided to do it because I mentioned it on a call that we had and, everybody seemed really interested in reading it and having a book discussion about it.
So we're going to do it sometime in October. So anyway, stay tuned for that. I might decide to open it to the whole Tigo community. Okay, so parents should stay in your therapy session if you are doing individual sessions. I highly recommend, and this is something I want to build more into my programs and my practice, that you get training
or train your team [00:22:00] on parent coaching. I know that Winnie Dunn has done a lot of work on parent coaching and has a lot of resources. I don't know other ones off the top of my head, but I do think that learning how to work effectively with parents and coach parents rather than Having this model that was way back when I graduated from college, 23 years ago, however long it was, 25, 24, 20, I graduated in 2000, so 24 years ago.
So when I graduated, you know, it really was like the therapist is the expert and the therapist takes the child away and the parent sits in the waiting room and it's very, but man, The results that you can get when a parent actually understands what you're doing and when you're looking at the parent and child as a, as a unit rather than that child as an isolated human, which no human is in isolation, our context and [00:23:00] our environments matter.
This is something that the OT profession has been saying for eons of time that our environments matter and the context in which we live matters. And so it's very important that we include parents in our sessions and that we learn how to work collaboratively with them in order to support their child.
I actually have played around with the idea of having services in my practice where it is just parent coaching and we don't even work with the child, it's just working with the parent, but we need to have some time to get systems in place and we need more staff in order to do something like that.
So maybe in the coming year or so, but I just want to give the parent coaching model a little lip service here on the podcast, because I do feel like it is so important and it's so effective, the research is behind it. Okay I hope this episode was helpful to you in deciding if you want to offer group or individual services or both.
The policies and [00:24:00] procedures around both need to be very clearly articulated in your practice. And some of them will carry over, but each service requires a different approach and different education to the family before they sign up. So they really know what they're doing. what to expect when they come into a group or an individual service with you.
That's it for this week. But! If you want to become a certified nature based pediatric therapist or therapist assistant, stay tuned because next week enrollment will open for our nature based therapy certification program in the Contigo Approach.
So we will open enrollment on Monday, September 23rd. and close enrollment on Monday, September 30th at 5 p. m. Central Time. So if you want to get more information about that, you can go to contigoapproach. com and read all the details there. Okay, I'll see you next week. [00:25:00] Bye!
