The physical location
To create a successful group, a relatively modest, private room, large enough to comfortably fit the number of people attending the group, is required. Individual chairs are preferable to couches, and the room should be big enough to allow participants to sit in a circle. A low table in the middle, to hold any relevant material, tissues, and possibly beverages, is desirable.
The group room should be a private, quiet space that is sufficiently sound-proofed, to minimise others from overhearing discussions. Access to private restrooms prior, during, and at the end of group sessions is to be included. Care should be taken in selecting the venue and time of the group, to ensure that in attending, participants do not become unwittingly identified by other community members.
It is desirable that there is a space separate to the group's circle of chairs where refreshments can be served, and the group members can congregate and socialise prior to the group and during the break (somewhere to go for a smoke will be important for some men). A separate area allows the group to have a mental break from the 'content', and to talk to peers. Access to an outdoor space for those who welcome a smoke break is also advisable.
It is recommended that some food and beverages are provided for the group members. When the group is being run as an evening program, men will typically attend straight from work, and may not have had the opportunity to access food. Refreshments can range from light snacks to more substantial food. An emphasis on healthy food (e.g. fruit) alongside biscuits, etc. is encouraged. Participants' diverse dietary needs are to be considered and catered for. Beverages should be the usual tea, coffee, water, and cold drinks - not alcoholic beverages. On occasions where a barbecue has been included, participants have commented on how sharing a barbecue is 'affirming' for them that this is a men's group.
Frequency & duration
Foundations is structured to run for eight consecutive weeks or sessions. Weekly sessions are ideal for maintaining flow of content, allowing sufficient time for reflection and processing information/learning, and for building connection and cohesion between the men. Running the group on a less frequent basis makes it difficult for participants to recall content from previous sessions, thereby adding extra time on review and catch up. It may also stifle the group's growth and cohesion, effecting comfort and anxiety levels, and limiting willingness to engage and share input. Offering the group more than one session per week may be considered, but runs the risk of the overall length of the group being too short (i.e. completing before participants become comfortable and able to get the most out the group experience).
An alternative to the weekly session format is to offer the group across two full days, plus an additional initial meeting, get-to-know-you planning session, and a follow up session. This can be useful for men with after work or shift demands, or who are just generally busy and have unpredictable calendars. This has been trialled and found to work with a Thursday evening (Session 1), Saturday morning and afternoon (Sessions 2-4), a week or fortnight later Saturday morning and afternoon (Sessions 5-8), with a follow up support and a wrap-up session within the month.
The eight session format supports a balance of process and content. It allows participants time to engage and become familiar with peers, as well as work through and integrate material. Like individual counselling, the space between sessions is an opportunity to reflect on the experience and practice learning. If the group runs for too few sessions, there is insufficient time for participants to get to know each other, and to feel comfortable enough to discuss difficult topics, or for preferred content to be covered. If the group is promoted as being too long (over 12 weeks or open ended), some men are reluctant to commit and enrol. In order for participants to get the most out of the group and enjoy the success of completion, it is important to make the group 'do-able'.
Each session of Foundations is designed to last two hours, with a short fifteen minute break in between. Given the 8 week format, this allows for roughly 16 hours of group programming. The structure of sessions and time breakdown is outlined in the Session structure section below. We have found it is important for facilitators to stick to agreed starting and finishing times as closely as possible, even if it means gently 'wrapping up' extended productive conversations.
Certainly, clients are welcome to come to the group venue early (15 minutes max) to settle and have some social time with fellow participants. While not part of the formal structure of the program, it allows for a sense of normalcy, as well as preparedness for the session.
It is recommended that a mid-session break of at least 15 minutes is adhered to. This allows the group participants to stretch their legs, have a mental rest, have something to eat or drink, go to the restroom, or to connect and engage with each other on topics other than group content. It also gives the group facilitators an opportunity to check in with each other, to ascertain how the facilitation is progressing, and whether any adaptations to content or processes might be made.
This section outlines the basic structure of each session of the Foundations program. Each session is organised with a similar structure.
Welcome, check In
Wrap up and check out
Each module or session is organised with a beginning check in, middle section, focusing on the identified content or discussion points for that session, and an ending check out. The check in and check out are important aspects of the program, as a process to warm up and warm down, supporting men to gently orient themselves and step into the group work, and to gently wrap up and step back out into their everyday lives.
Check in is about welcoming men into the group space, and for them to take a moment to check in with themselves, as well as with group members and facilitators. Facilitators play an active role in supporting and shaping each week's check in process, beyond general housekeeping, welcoming participants, acknowledging apologies, facilities and refreshments, name tags, cell phones off, etc.
In deciding what might be the general and specific focus of each check in, facilitators will want to be mindful of the session's upcoming topic or points of discussion. Ideally, check in becomes a 'known' routine for the men that they become familiar with over time, to the extent that they become self supporting and self facilitating. Check in can be
- An opportunity to pause and reflect on content covered and learning experienced; AND
- an opportunity for the men to note any significant events of the past week; AND
- to comment on current well-being.
However, whilst discussion of each of the 1, 2, and 3 areas can be useful, trying to cover all three areas at each check in each week will result in a significantly extended and potentially counter productive check in.
In order to support participants learning, it is important for facilitators to be open and transparent, and to possess a clear rationale and sense of purpose in focusing each check in. It is suggested that facilitators choose between:
- Inviting participants to reflect on content covered in the previous session, and to identify what is meaningful and useful (or not) for them. This will help participants to integrate and build learning.
- Inviting participants to share any significant events or learning of the past week. This will help to update fellow participants and facilitators 'where they are at', as well as grounding discussion in the reality of men's everyday lives. In order for this to be useful, it is important to support participants to move beyond a simple list of events, and to include reflections on the thoughts, feelings and actions the men experienced with respect to these events, and how this relates to their involvement ('what they are there for') in the group.
- Supporting participants to provide an account of current well-being that recognises different domains of well-being: physical, mental, emotional, relational, and for some, spiritual well-being (See the 'check in' on Session 3: Challenge men face and Session 5: Emotionally engaged living to provide framework that supports men to acknowledge, identify, and express emotions/feelings).
Check out is an important element of the group process. Whereas the challenge in relation to check in is often to ensure it is focused and does not become overly long, check outs can often become too rushed and crunched down. Check outs are an opportunity to breathe, to take stock, to review learning, and to articulate the personal meaning and 'take away' for them. Facilitators play an active role in supporting participant well-being in wrapping up by acknowledging the contributions of each of the participants, providing an account of the content covered in the session, and orienting participants to the upcoming sessions topics.
Facilitators are encouraged to include a grounding, mindfulness or relaxation exercise as part of the check out routine. This supports participants to become aware of their own thoughts and reactions, and to manage any stress responses that may have arisen during the course of the group. Furthermore, it ensures that participants are oriented to paying to attention to the here and now of their own well-being prior to leaving the group. When introducing grounding, mindfulness, and relaxation exercises, facilitators are encouraged to select an exercise that is tailored to the needs of the particular group members and the content covered. Suggestions are outlined in this module/manual and in the Facilitator resources.
Another important aspect of the check out is that it is an opportunity to obtain feedback from participants. The Group Session Rating Scale (GSRS) (pdf file) is one possible means to support individual reflection, and obtain feedback that can be used to adapt and improve group processes and overall program facilitation.
Resources and evaluation
This section details different resources, and methods of review and evaluation, to help maintain a beneficial Foundations program for participants and facilitators.
Foundations can be facilitated and supported with minimal resources. As introduction of psycho-educational material plays a role in the program, a whiteboard and/or flipchart paper is a useful resource. Name tags, notepads, and pens are a good idea (although name tags won’t suit everyone). Participants are provided with a program workbook and additional handouts, so they don’t need to be busy writing down key program content.
Whilst Foundations can be facilitated with minimal resources, the introduction and use of creative media resources is recommended. Creative, therapeutic, and group work material, such as photo language, relationship, strength cards, symbols, etc., are useful conversation starters, and tools for reflection that can support participants to identify and express themselves (recognising that not everyone will be as confident and comfortable expressing themselves verbally). Videos such as Boys and Men Healing, or The Bristlecone Project, or other material available through social media, can provide valuable topic introductions and discussion points. A computer/projector, TV/DVD, CD player or tablet is therefore recommended.
There are two components of evaluation within Foundations: process evaluation and outcome evaluation. Both are key to providing valuable feedback, in terms of program functioning and impact, on the group members. This section will explore both forms of evaluation.
It is important to evaluate the group to ensure that it is running as planned, that the participants are benefiting, and that changes are made as needed. It is integral to ensuring best evidence-based practice. Evaluation is regularly overlooked, usually as a result of resource constraints. It is important that the evaluation process privileges the men’s own descriptions and reflections.
Here are some further thoughts to consider:
- How will you know that the group is working for the men, in both the short term and long term?
- How will you measure both the group process/experience and the group effectiveness/outcomes?
- Is evaluation designed to reflect and improve on the organisation’s or the facilitators' practice, or both?
- What methods of evaluation will best suit your needs and those of the participants?
- What types, or mix, of qualitative and quantitative data are you interested in?
- What resources are realistically available to you?
It is useful to consider an independent external evaluation. Is it possible to form a partnership to assist with evaluation (for example, the social work or psychology department of a university).
The Group Session Rating Scale (GSRS) (pdf file) is a useful tool for providing immediate feedback of a participant’s experience in each particular session (Miller and Duncan 2000; Miller & Bargman 2012). The GSRS takes approximately 2 minutes to complete, and provides a snapshot of the degree to which the participants:
- Felt understood, respected and accepted by the facilitator.
- What was worked on and talked about was what the participants wanted to work on and talk about.
- The facilitator and group approach fitted for each participant.
- An ‘overall’ rating as to whether they felt part of the group and it felt right for them.
In addition to rating the group session by placing a mark on a line in relation to positive and negative statement about the four areas, additional qualitative feedback is sourced as participants are invited to provide written comments how they found that particular session. The GSRS provides an opportunity for participants to reflect on and document how each particular session has been for them, and is an added means for the facilitators to gather feedback and hear from participants. One of the legacies of child sexual abuse is that men can learn to present in group environments as if they are engaged and everything is ok, and if asked will assert that they are ok, even when struggling. The GSRS provide an additional means by which to hear from participants about their current experience, and can act as a prompt to facilitators to follow up and check in with participants if they rate their experience strongly negative.
Towards the middle of the group (e.g. Week 5), facilitators are invited to conduct a focused evaluation/check in with the group members, in relation to achievement of the identified group's hopes and aspirations. This is also an opportunity to revisit the group agreement developed in Week 1, and to check whether any modifications are needed. The mid-group review is an opportunity to look again at identified content and themes, and to consider any adjustments or additions, recognising that participation in the group can bring to the fore content and questions that had not previously been considered.
Facilitator debriefing & evaluation
As indicated previously, at the end of each session, facilitators are invited to spend a minimum of 30 minutes to debrief and check in with each other, to discuss aspects of session that worked well, and what would benefit from improvement both in the current group and for future groups. The 'Post-session facilitator's review' is designed to support a focused debrief that reviews each session’s content and process, as well as prioritising participants' and facilitators' well-being.
End of group feedback form
In the final session, participants are provided with an 'End of group feedback form' that asks them to rate and give feedback about various elements of the group program. The 'End of group feedback form' provides predominantly qualitative information that is to be collated, reviewed, and utilised, to adapt and improve the quality of future Foundations groups.
Foundations utilises the PCLC Trauma Checklist and DASS as additional means to measure program effectiveness and outcomes in managing the effects of trauma and enhancing well-being. These are introduced prior to commencing the group, upon its completion, and, if resources exist and participants are in agreement, at a 3 month or 6 month follow up.
While some men may enjoy the structure of scales and questionnaires, others experience them as alienating and overly clinical, so some care and thoughtful preparation is needed when introducing quantitative measures. Facilitators need to be clear about the purpose of utilising such measures, and to take time to explain this to participants. In particular, it can be helpful to explicitly state that the assessment tools are not for the purpose of making judgments, or evaluations of how individuals within the group 'measure up', but is one means of gathering information to ensure the group program is effective and working for them.
When conducting the Foundations end of group review, the following resources are all to be drawn upon and utilised:
- The Foundations Group's Hopes and aspirations.
- Mid-group review.
- PCL-C trauma checklist.
- DASS results.
- Weekly facilitator’s Post session facilitator's review form.
- End of group feedback form.
- Group Session Rating Scale (GSRS) (pdf file).
Now is a time to identify the learnings for the Foundations group program and for the facilitators, in addition to what adjustments would benefit and improve the program, and better meet the needs of the men who have been sexually abused in childhood. In so doing, it is useful to remember that Foundations, as an 8 week/session program, is designed to support development of stronger foundations, which are to be subsequently built upon. The identified learning from the end of group review can be utilised to shape future service delivery.
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