Using an ICF-based participatory method for supporting goal setting in a CR group

Cognitive impairment is a core component of schizophrenia negatively affecting occupational performance. Cognitive Remediation (CR) has been developed to improve these deficits. At Helsinki University Hospital (HUH),... [ view full abstract ]

Cognitive impairment is a core component of schizophrenia negatively affecting occupational performance. Cognitive Remediation (CR) has been developed to improve these deficits.

At Helsinki University Hospital (HUH), Psychiatry Unit CR is practiced in both individual and group settings.  The group model used is the Neurocognitive Educational Approach (NEAR). The group is a closed group consisting of 6 members attending 1,5h sessions 2 times a week for a total duration of 10 weeks. Setting individual, meaningful goals linked to everyday functioning prior to the group intervention is a challenge.

The SPIRAL game was developed to support goal setting in mental health rehabilitation. Based on the ICF the game focuses on functioning in daily contexts and can be used as a participatory method for goal setting. A self assessment form is filled out and the different topics are discussed during the game. 

Combining the Spiral game to NEAR has proven promising. The game provides a frame of reference from the ICF point of view, while peer support offers discussion based on experience. Members play an active role in setting their own goals based on their needs and interests. The group leader helps specify how specific cognitive functions impact occupational performance in daily activities and how to modify challenges identified in the SPIRAL game into goals. This process contributes to increased awareness concerning both functioning and how CR can support rehabilitation. Linking goals to address specific perceived challenging tasks helps in individualizing the intervention. Linking NEAR to meaningful occupations results in intrinsic motivation enhancing attending sessions, completing homework and ultimately transferring the gained skills to general functioning in everyday settings.