Engagement in Group Process in Multifamily Psychoeduction Groups for Families Coping with Hepatitis C

Introduction:  Small group research has historically demonstrated the effect of group-level factors on outcomes independent of individual group member characteristics.   There exists a consensus that knowledge and skills in group dynamics are necessary for facilitators to maximize the positive effects of small group interventions.  Multifamily psychoeducation--an evidence-based model based on a combination of education, support and problem solving--shares this conclusion, with multiple programs incorporating group dynamics theory and group skills into training manuals and supervision.   In spite of the consistent affirmation of group-level constructs as essential to psychoeducation, there has been remarkably little empirical examination of the role of group-level factors in psychoeducation.   Therefore, the purpose of this presentation is to examine the effect of group cohesion on individual outcomes in multi-family psychoeducation groups for families with a member with Hepatitis C (HCV).

Methods:  PsychoEducation Responsive to Families (PERF) is a model developed initially for families coping with a member with mental illness, and subsequently translated to focus on families coping with HCV (HCV-PERF).  HCV-PERF consists of 12 90-minute sessions, which include a didactic presentation, brainstorming and problem-solving.  PERF is co-facilitated by a clinical professional (generally a social worker) and a medical professional.  The unique feature of PERF as a model is that group participants create a unique curriculum, which is then delivered through manualized procedures.

The current presentation examines group participants in the HCV-PERF arm of a clinical trial (n=47 completed cohesion scales out of 209 randomized to the intervention group; and n=12 for facilitators).  At the mid-point of the group, participants and facilitators completed a 6-item group engagement scale (GES), adapted from one initially developed by Rose (2001).  The instrument specifically measured perceived usefulness of the group, positive experiences, leadership competencies, and ratings of group utility.  Aggregated scales scores were created for both group participants and facilitators, and these scale scores were used to predict likelihood of a variety of outcomes immediately post-group and six-months post-completion. 

Results:  At group completion, greater cohesion was associated with decreased drug use and likelihood of smoking, number of problems reported in the past month, and decreased reported functioning in the past month; and increased satisfaction in quality of life, likelihood of receiving HCV medication, and readiness for change.  At six-month follow-up, greater cohesion was associated with decreased likelihood of smoking, and increased treatment satisfaction and number of problems reported in the past month.

Discussion:  Overall, among groups where the GES was completed by the group members or facilitator, findings were generally positive with greater cohesion associated with a variety of positive outcomes.  Even potentially negative findings (decrease in functioning at group completion and increase in number of problems reported) may be related to increased knowledge and awareness.  Despite significant limitations (treatment drop-outs in particular) the findings affirm the importance of cohesion as a group-level factor in predicting individual change and point to the need to train social work practitioners in group-level practice skills.