Support Groups for Children and Teens

Guidelines and Suggestions

1. Planning

Sample Goals (For Facilitators)

• To create a “safe” and accepting environment for participants.

• To provide an environment in which participants can feel comfortable sharing their burn and recovery related experiences.

• To use a mix of purposeful activities and discussion/sharing through which participants can develop coping skills and social skills

• To help children build bonds/relationships with group members for ongoing support and belonging • To create a format and environment in which children/teens have repeated attendance/participation in group sessions. 

Pre-Plan Your Activities

1. Icebreaker or collaborative group task.

   Basic icebreakers can start a group off on general participation. Consider using an activity or task that requires teamwork and participation of all members. While icebreakers are helpful in getting the group to be more generally comfortable, actually working together at a collaborative task will further gel the participants’ relationships. Relationships and teamwork help make those bonds that cause children to truly feel more comfortable and safe for sharing and discussion, and for repeated group attendance. For additional ideas, please refer to the reference list at the end of this handout.
   

   Note: Be ready with several icebreakers/ collaborative tasks in case your group appears to need multiple introductory activities. 
   
   

2. Focus activities:
   Facilitate a tangible experience or produce an object for reflection and discussion. This will provide opportunity for participants to create, reflect, and produce something they can talk about during your discussion/processing section. 
   
   
   

3. Examples of activities:
   Family tree, personal coat of arms, worry dolls, dream catchers, choose a photo from a pile of examples and re-draw it according to your own reality, personal drawing puzzles (represent a certain topic, then break apart and discuss meaning of this), body drawings, tracings of our shoes/drawing our path, read a book together followed by discussion.
   
   
   

4. Take-home activities: 
   Some participants will want to continue working through their feelings after the group experience/between group sessions. Consider providing a journal (for picture drawing or writing, depending on participants’ ages), helping the children to start a scrapbook, or a semi- structured workbook—there are several emotional processing-type workbooks listed in the reference section. 
   
   
   

Also consider some type of handouts for the parents that will give them ideas on some of your focused activities and suggestions of how to create an environment for open dialogue processing for the child or adolescent. 

2. Implementation

Set the Tone

Provide a basic, age-appropriate introduction, such as: “In this group, we all have something in common: all of our lives have been impacted by burn injury. We’ll use our time together for sharing, listening, learning from and being supportive of each other.” 

Introduce "Ground Rules" for the Group

1. We take turns speaking here.

   One person talks at a time. Everyone can speak if they want to, but no one has to talk.(Consider using something tangible such as a talking stick to represent the speaker’s turn.)
   
   

2. All feelings are okay.
   No one’s feelings are ever wrong. They are what they are, and that is okay here.
   
   

3. The Platinum Rule:
   Treat other group members as they would like to be treated. If you are unsure, how someone wants to be treated, ask them! (This will help you meet each child/teen “where they are” in the context of a support group).
   
   

4. What is shared in this group stays in this group.
   Ask group members for their commitment to confidentiality. If people come in late, briefly mention boundaries to them also.

   Exception (be sure to say this): “I care a lot about helping you. If you tell me (and/or the group) something that I think is dangerous or unsafe for you, I have to help protect you by telling another adult who can help. I want to help keep you safe and help to make sure you’re okay.”
   
   

5. Invite participants to add ground rules if appropriate.
   
   

Introduce and Facilitate an Activity (Optional but recommended for most age groups vs. pure “discussion-only” group time) 

1. Icebreaker or collaborative group task. 
   Use a task or activity that requires teamwork and participation of all members (such as completing a puzzle together, without using hands, or without using words). While icebreakers are helpful in getting the group to be more generally comfortable, actually working together at a collaborative task will gel the participants’ relationships. Relationships and teamwork help make those bonds that cause children to truly feel more comfortable and safe for sharing and discussion, and for repeated group attendance. 
   
   

2. Focus Activity. 
   Facilitate your activity (project, reading a purposeful story, etc.), be attentive to participants’ attention span, grasp of material and instructions, need for assistance, changing directions, and session timing. Be sure to leave time for discussion and processing. 
   
   

Discussion/Processing Time

Use open-ended questions. A few examples:

• Who would like to tell us 2-3 sentences about their project?

• Can you tell us more about that ____________ ? (be concrete)

• What did you learn by making/doing today’s project/experience?

• What (if anything) are you planning/hoping to share with your family about (today’s project or experience)?

• What might be easy or difficult about sharing this with your family?

• What have you learned or said here in group that you want your family/classmates/friends/etc. to know?

• Link your participants’ experiences: Has anyone else had a similar experience?/Does anyone feel the same way?
  
  

Invite all participants to share: Make sure that all have opportunity to speak; be aware of children who might dominate the conversation. (Avoid going around the circle in a particular order; this forces participants to speak before they are ready to share). Invite the shy/quiet participant to speak: Use targeted eye contact and a gentle verbal invite (such as calling the child by name) to share for participants who have not had a turn.

Again, a tangible “turn-taking” object is helpful here (such as a talking stick). 

Closing

1. Thank participants for their participation, work, and sharing (cite specific examples if appropriate)
   

2. Provide information for next meeting. Mention specifics and enticements for attendance (highlight exciting plans or incentives). Also, assign "roles" for next time if appropriate, "e.g. Johnny can help with the snack, Susie can help lay out the materials, Joey will help with chairs."
   

3. If your participants are doing journals, scrap books, or other projects at home, remind participants of the value in this work.
   

4. Leave open-ended offer for help/support (for getting further help) if needed between now and next group time. For example, if you are available to talk to participants via phone, or if issues arose which participants may need to discuss with a parent or trusted adult, encourage them to do so with concrete suggestions. (Note: This could also be a private conversation with a participant if appropriate.) 
   
   

3. Recommendations and Notes

Creating the Environment

1. Minimize distractions

   Be aware of what is going on outside the windows, the light level, background noise, etc. Make sure all children have put away other objects and possessions.
   
   

2. Respect children’s physical boundaries.

   Ask permission to hug or touch. Listen while people are sharing.
   
   

3. With older children and teens: ask permission to comment.

   It is fine to let others know that you would rather they didn’t comment on what you shared. Advice-giving: different way of listening; be with the person, not trying to fix it
   
   

4. Use of a tangible object (such as a talking stick) will help to keep the focus on one speaker at a time.
   
   

5. Small group size is beneficial.

   A small group, especially with children, can be an asset to ensuring comfort, participation, and management of behaviors during the group. While many would judge the success of an ongoing group solely on attendance rates, know that regular attendance and active participation from a smaller number of children is a legitimate measure of success.
   
   

6. Close the group process
   Thank people for attending, sharing and listening to each other. Remind the group of commitment to confidentiality. Suggest/provide/offer children and adolescents a safe and appropriate outlet for continuing to express their feelings outside of the group setting. (Suggest talking to a supportive adult, drawing, or writing in a journal, etc.) If there is a plan for group to continue/have future meetings, be concrete with plans (say it, write it, give it (on handouts)).
   
   

7. If the group occurs within a camp setting (or other time-limited contact) praise participants for their sharing and how well they have bonded as a group; provide tangible examples of other ways that they can work together and support one another during the rest of camp. 
   
   

Suggestions for Overcoming Common Challenges of Support Groups for Youth

1. Participants’ age groups are too diverse
   Consider offering two (or even three) separate group sessions. Share the facilitation tasks with professional peers, or possibly schedule back-to-back times so that families who travel for group will only make one trip. If you must keep a large variety of ages in one group setting, consider having consistent or occasional small group break-out sessions for tasks or discussion of more sensitive topics (such as intimacy for teens). Knowing your participants’ needs and dynamics will help you judge this.
   
   

2. Attendance is sporadic (due to distance, time, school commitments)
   Children/teens will ultimately be reliant upon their families for transportation to group. Offer parking or gas cards to ease the financial burden of traveling to the group location, and provide food if possible. Strongly encourage attendance but do not require it or shame participants who are unable to consistently attend. If you are able to offer attendance via Skype (free videoconferencing) or similar options, this could link in participants from greater distances. (Be sensitive about your activities if you have children participating via videoconferencing so that they do not feel left out). Also, consider regional support groups that are closer to home areas for participants; whether you are able to travel to facilitate these or utilize a more local professional resource.
   
   

3. Sibling dynamics
   Find out the background on your participants. You will likely begin to see issues that occur in the home setting (such as jealousy or one dominant speaker). Make sure to verbally recognize all participants as a part of the group, noting that everyone impacted by a burn is a survivor. Be sure to invite all siblings to speak in an equal manner. You may choose to have break- out sessions during group, and could offer a sibling small group for more focused discussion topics.
   
   

4. Some children/teens do not actively choose to attend group
   Recognize that participation level could reflect this factor; parents/guardians requiring attendance removes the child’s control. When possible, provide choices and control to the child. Be sure to verbally recognize your gratitude for their attendance and use tangible examples of how they make a difference to the group. (Example: “I’m really glad you came tonight. You really helped the group solve the puzzle exercise with your idea. I know [other group member] like seeing you here too.”)
   
   

5. Continued reluctance of children/teens to “open up,” participate, or share
   Invite guest speakers whose stories and discussion style sets the tone. Infuse a few “peer mentor” style participants (of the same age group or only slightly older than participants) whose own sharing/participation can help members to open up.
   
   

6. The environment seems to be a barrier for attendance; burn center vs. foundation vs. neutral community environment
   Consider the fact that many children and teens experience anxiety at entering the hospital/clinical setting. Even attending a potentially fun and supportive event like a group can evoke these feelings and may cause the child not to attend group. On the other hand, foundations and other community locations do not automatically provide the association of a supportive and caring place for new participants. Balance these issues; continue asking participants and caregivers for input.
   
   

7. Participants express need for support between meeting times or at home
   Discuss options with the child’s parents/guardians, offer school reentry type support (remember, school reentry programs are useful at each change of peer group or even with new teachers). Consider developing a local mentor for the child, teen, siblings, or family. This can help provide a local resource for assistance with reentry into the home community. Suggestions include a teacher, fire fighter, a SOAR(trained peer support) volunteer etc.
   
   

8. Keeping a group fresh/exciting/interesting, meeting after meeting is a challenge
   Keep basic elements routine/predictable/safe so that participants can comfortably know what to expect. Infuse guest speakers, new activities, and a variety of media and sensory activities (movies, physical activities, creative projects, etc.) to keep content fresh. Many professional organizations have forums for information-sharing; talk with professionals in your area and across the country to share ideas!
   
   

9. Participants gain a great deal from the group process at camp/time-limited setting, but have no follow-up
   Encourage your local burn center or foundation to provide aftercare programming throughout the year (ongoing support groups, regular camps, family days, etc.). Online tools such as the Phoenix Society chat room can offer a safe/secure forum for further support and meeting up with fellow campers. Provide a tangible memento of the experience that participants can take with them. Having a token from the experience can be a reminder of the benefits of opening up, sharing your story, having confidence and support, etc. (Example: Each participant has a “Great things about Johnny” list which everyone has an opportunity to write on).