study explored the impact of a modified Fairweather Lodge on the
development of group cohesion and self-efficacy for nine severely
mentally-ill clients. The Fairweather Lodge model is a
psychosocial rehabilitation model combining congregate living with
collaborative employment. It differs significantly from
traditional group homes with “Lodge” members assuming almost complete
autonomy with regard to establishing rules and procedures, as
well as in taking primary responsibility for site operations.
Employment and Lodge member independence are emphasized. Our modified
version of the model highlights the group-as-a-whole therapeutic
position. This perspective, originating in the Tavistock
tradition, focuses on the group-as-a-whole’s contribution to the tasks
of connection and rehabilitation versus any given individual’s actions.
Consultant interpretations address processes operating outside the
current awareness of the group that might impede the task (anxiety,
depression, etc.). Group members work together to promote
growth. Ten subjects completed the 16-week evaluation period in the
Control Group setting (standard group home) and nine subjects were
evaluated under the modified Fairweather Lodge Model. Baseline
measures of self-efficacy and cohesiveness before the start of
treatment were compared between groups by unpaired t-tests.
Significant changes from baseline were determined in each group by
repeated measures analysis of variance with Tukey Tests used for
post-hoc testing. There was no difference between the Control and
Experimental Groups at baseline. After the 16 week treatment, an
individual’s sense of self-efficacy (on average) did not change in the
Control Group, but increased by 45% in the Experimental Group. The
Lodge setting also produced a 35% increase in cohesiveness from
baseline to 16 weeks of treatment.
homes were developed by mental health workers in the 1960’s and 1970’s
as part of the deinstitutionalization movement. This movement involved
the closing of public hospitals and the transfer of services for the
mentally ill into the surrounding community, where they could be
provided in “the least restrictive environment” (Bachrach, 1980). Group
homes are typically small residential facilities located within a
community. They are intended to simulate family life.
the deinstitutionalization process fell short. According to the
National Alliance on Mental Illness (NAMI, 2008), of those individuals
with a severe mental disorder only 40% receive needed treatment
services on any given day. This results in homelessness, imprisonment,
and at times violence. Forty-two of the fifty states have less than
half the minimum number of beds needed to house the mentally ill. Many
severely mentally-ill individuals are forced to reside in long-term
care facilities or nursing homes (highly restrictive environments),
designed to provide care for people unable to care for themselves
(National Center for Health Care Statistics, 1999). The population of
mentally-ill individuals residing in these facilities is growing. Many
of these individuals are under the age of 65 and have few other housing
options. The lack of housing and treatment for the mentally ill, in our
view, is a national crisis.
In response to this crisis, we
propose that, contrary to what is implied by existing opinion, the
application of an analytic “group-as-a-whole” model of therapeutic
treatment to community living (in the context of a Fairweather Lodge)
can improve the basic effectiveness of the group home design. This
conclusion in turn may help strengthen the argument for developing new
group homes. Our study suggests that clients with severe mental illness
can benefit from treatment often considered intellectually and
emotionally beyond them. We examine our approach to treatment as it
positively affects two key factors of group home life: group cohesion
and the self-efficacy of group members. We applied group-as-a-whole
treatment to a group home (a Fairweather Lodge) partly because the
treatment appears well designed for alleviating and responding to the
severe isolation which individuals with mental illness tend to suffer
from. Group homes are intended to counteract this isolation. The Fairweather Lodge
typical group home stresses maintenance and provides 24 hour
supervision. There are few treatment options offered beyond medication
management. There is limited focus on developing group cohesion or
self-efficacy through team building, vocational training or
psychotherapy. Typical group homes offer residents few opportunities
for exploring their need for positive relationships, or the impact of
isolation and depersonalization (due to mental illness) on their
psychological well-being (Edelson, 1970).
Recently, two U.S.
organizations devoted to advocacy and housing for the mentally-ill
population (we shall leave them nameless) collaborated to bring about a
Fairweather Lodge group home (the first of its kind in its state). A
group-as-a-whole treatment model was gradually introduced, creating the
basis for this study. The Fairweather Lodge group home model was
developed by Dr. George Fairweather in 1963 in response to the
deinstitutionalization movement. His is a psychosocial rehabilitation
model, combining congregate living with collaborative employment. The
model focuses on rehabilitation and the promotion of autonomy for Lodge
members (Fairweather, 1964; 1980). A “Lodge” is an affordable dwelling
whose members share running the home, including domestic chores and the
purchase and preparation of food. Unlike in most traditional group
homes, Lodge residents make their own house rules and manage their own
activities. Moreover, they collaboratively design and run a small
business. Such businesses may offer cleaning services, printing,
furniture building, etc.
The Lodge model stresses part-time
employment and Lodge member interconnectedness. Unlike in
traditional group homes, where staff members provide 24 hour on-site
control over the day-to-day operations of the facility, Lodge staff
duties are limited to mentoring, advising, mediating, and helping in
emergencies. Lodge staff includes one Lodge coordinator and one
vocational trainer, who remain on-site during weekday hours only. A
Lodge thus costs much less to run than a typical group home.
Research supports the effectiveness of the Lodge model (Fakhoury et
al., 2002).The Group-as-a-Whole Model
explores the impact of a modified Fairweather Lodge on the development
of group cohesion and self-efficacy for nine severely mentally-ill
clients. The modification consists in applying the group-as-a-whole
treatment model to the Lodge. This model, rooted in the Tavistock
tradition, focuses on the group-as-a-whole’s contribution to the group
and to individuals’ actions.
According to the
group-as-a-whole model, staff interpretations of group behaviors take
into account unconscious group processes (anxiety, depression, etc.)
that operate outside the current awareness of the group, processes that
may interfere with the major tasks of connection and rehabilitation.
Interpretations are made by a “consultant.” These interpretations teach
group members to become more sensitive to underlying group dynamics and
one’s own role within them. A group-as-a-whole therapeutic perspective
was fostered through 1) bi-weekly group psychotherapy sessions and 2) a
social psychological perspective maintained by staff that any given
individual’s behavior is influenced by the whole group, and not solely
by individual psychodynamics. The group-as-a-whole model involves some
integration of psychodynamic theory. The exact nature of this theory is
not prescribed, but one quite frequently finds elements of traditional
and object-relations theory in Tavistock consultations (Hazell, 2005).
group-as-a-whole process refers to those conscious or unconscious
dynamics relevant to the group as a specific psychological
construction. One of the most extensively discussed group-as-a-whole
processes in the empirical literature is group cohesion. As we will
consider shortly, group cohesion plays a fundamental role in the
ability of a group to be therapeutic. In our study, without prompting,
the Experimental Group (the group applying the group-as-a-whole model)
began to explore dynamics that interfered with group cohesion and
worked to overcome them. Beyond considerations of cohesion, the
group-as-a-whole can be perceived, experienced, and represented in the
minds of the members with a range of positive and negative qualities
(Greene, 1999). The group can be experienced, for example, as the
unconscious “good mother” with protective and holding abilities
(Scheidlinger, 1974). The group can be experienced as the unconscious
“bad mother,” who can annihilate an individual (Agazarian, 1989). These
opposite experiences of the group, formed from shared projections, have
been well described in the literature. Other group processes
examined serve defensive or work-avoidant needs (Bigelow, 1998).
Bion (1951) explored fundamental assumptions of unquestioned dependency
(for example, on the consultant), fight–flight, or again the delegation
of a strict, turn–taking pattern of exchange of ideas, all often
arising due to anxiety among the group members (Rioch, 1970).
Such assumptions and processes need to be dealt with via
interpretation or confrontation by the consultant in order to shift the
group toward more task-oriented and less defensive behavior (Ettin,
1992; Yalom & Leszcz, 2005).
A consultant working in the
Tavistock tradition might, for example, sense that a group that is
discussing the desire to go on a trip may be avoiding the task at
hand. The consultant may address this discussion with a
group-as-a-whole interpretation by stating, “This group is uneasy about
dealing with something in this room and desires to move away from it,
to go on a trip instead, rather than to address this uneasiness.”
The consultant became aware of the group’s escape from the task through
members’ comments on events outside of the group’s process. The
consultant’s interpretation was intended to re-focus the group’s
discussion back on the dynamics developing in the here and now.
deal with anxieties, groups can form us– versus–them, or in–versus–out
polarities where some members disown aspects of themselves and project
them into some other part of the group, or into an external group.
(Agazarian, 1997). These externalizations are usually a defensive means
that can undermine accomplishing the group’s task. The process of
splitting and externalizing needs to be dealt with by the consultant.
approach of the consultant interpreting the dynamics of the group
stresses the interconnectedness among members. This appears to reduce
the tendency for scapegoating when discussing particularly
controversial subjects. In addition, the approach contributes to the
development of a holding environment, which encourages clients to
share and to face painful issues. (Semmelhack, Ende, Hazell,
Hoffman, and Gluzerman, 2009). Group Cohesiveness
study measured the effects of group-as-a-whole treatment on group
cohesion and self-efficacy. Group cohesion can be defined as feelings
of trust, belongingness, and togetherness experienced by group members
(Burlingame, Earnshaw, Hoag, Barlow, Richardson, Donnell, 2002). There
is increasing agreement that cohesion is the best definition of the
therapeutic relationship in a group (Burlingame, et al., 2002).
Cohesiveness appears to be as important, if not more important, in
describing a patient’s improvement, than what theoretical orientation a
therapist adheres to (Norcross & Godfried, 2001). Cohesion is
defined in a group setting as to multiple alliances (e.g.
member-to-member, member-to-group, member-to-therapist,
group-to-therapist) (Burlingame, et al., 2002). We examined group
cohesion both because of its importance for group therapy and
because of its ability to counter the isolation characteristic of the
severely mentally ill.
Bion (1951) has stated that we are group
animals at war with our groupishness. He suggests that while as group
animals we desire to be in groups, we also fear groups and what they
can do to us and others. There is a field of forces that each human
being must negotiate--forces pulling us towards the group and forces
pulling us away from the group. The net effect of this force field
results in the individual’s level of membership or belonging to a
group. When this force field is aggregated across all of the members of
a group, one could call the result the group’s cohesiveness.
to Yalom, Houts, Zimerberg, and Rand (1967), group cohesiveness
predicts successful outcomes in group therapy. The development of
cohesiveness appears to have a curative effect (Yalom, 2005).
Marmarosh, Holtz, and Schottenbauer (2005) agree, finding cohesion to
be a primary group factor, “‘directly related to curative group factors
such as “collective self-esteem” (i.e., the self-esteem one gains by
being a member of a group) and “hope for the self” (similar to
optimism) (p. 36). Self-efficacy
examined the effects of group-as-a-whole treatment on self-efficacy in
members. Self-efficacy is a crucial concept in the work of psychologist
Albert Bandura. According to Bandura, self-efficacy indicates “the
belief in one’s capabilities to organize and execute the courses of
action required to manage prospective situations” (1999, p.2). In more
common language, this means that self-efficacy represents an
individual’s belief in her ability to succeed in the situations she
encounters. Self-efficacy affects our motivation, behavior, and
We examined self-efficacy because it is
key to the development of autonomy, a major issue for the Fairweather
Lodge, as well as for the group home in general. We believe
group-as-a-whole treatment improves self-efficacy because it raises
self-esteem and helps members to internalize the group as a soothing
object which can be called upon in times of stress. These factors can
reduce anxiety and thereby increase both ego functioning and task
Most individuals have goals they would like to
achieve and aspects of their lives they would like to change. Bandura
(1999) has found that self-efficacy plays a vital role in how people
approach their goals, tasks, and challenges. He suggests that
individuals with a strong sense of self-efficacy tend to view
challenging problems as tasks to be mastered; tend to develop a strong
commitment to their activities; and tend to recover quickly from
setbacks. On the other hand, Bandura suggested that individuals with
weak self-efficacy tend to avoid challenging tasks, focus on
personal failings, and quickly lose confidence in their abilities.
According to Bandura, self-efficacy begins to form in
early childhood. It then develops throughout life as we process new
experiences and acquire new skills. Bandura has pointed to four
major sources of self efficacy: mastery experience, social modeling,
social persuasion, and psychological responses. He proposed that in
mastery experiences we perform a task successfully, which strengthens
our sense of self-efficacy. On the other hand, continuous failure in
responding to challenges weakens self-efficacy. As for social modeling,
Bandura suggested that witnessing others successfully completing a task
strengthens the observer’s belief that she can master it. In social
persuasion, the encouragement of others convinces people that they have
the skills to succeed. Finally, psychological responses play an
important role in self-efficacy. Bandura suggested that emotional
states, moods, physical reactions, and stress all affect how we feel
about our abilities.Previous Research
problems have confronted researchers studying group home effectiveness.
Most of the studies have been non-controlled follow ups, cross
sectional surveys, or non-randomized controlled trials (Fakhoury,
Murray, Shepherd, & Priebe, 2002). There have been few outcome
studies regarding the effectiveness of housing. There are difficulties
due to practical and ethical problems that make randomized controlled
trials hard to conduct. Fakhoury and colleagues report that the most
common type of research has been cross-sectional, but one cannot
determine causality from this research (Fakhoury et al., 2002). Despite
growth in group housing, little research has been done on the
effects of living arrangements, or the support available to residents
(Nelson, Walsh-Bowers, & Hall, 1998).
Avella, and Fairweather (1980) showed that the Lodge provided a better
track record in terms of recidivism and employment than most other
forms of community aftercare. Persons who were members of the Lodge on
average remained within the community much longer than their matched
pairs in other community treatment programs. Lodge residents were more
frequently employed, and the cost of operating Lodge programs was less
than that of other programs. When the Lodge became completely
self-governed by the members, it also could be somewhat self-supporting
by the employment income of members, which provides a further measure
of the cost-effectiveness of establishing a Lodge (Tornatzky et al.,
Though there has not been extensive research done on the
effectiveness of the Fairweather Lodge model, some other research has
been compiled. Onaga, McKinney, and Pfaff (2000) examined the variables
behind the success of the model by looking at 74 Lodges throughout the
nation. One main theme that surfaced was that Lodges were similar to
families in that they emphasized mutual support, shared resources,
common goals, a sense of community, a nurturing environment, and an
integration of values.
Haertl (2004) explored factors
contributing to the success of clients in a Fairweather Lodge through a
mixed design study. The results indicated that success in the
Fairweather Lodge model depended on the following variables:
willingness to work, assimilation to the community environment,
receptivity to peer support, work and living skills, ability to
experience a higher quality of life, empowerment, sense of community,
Limited research has been conducted on the
utility of the group-as-a-whole model in creating a sense of cohesion
or self-efficacy with severely mentally-ill populations housed in
community based settings (Hazell, 2005; Semmelhack, Hazell &
Hoffman, 2008). Most of the work available on the group-as-a-whole
methodology provides qualitative descriptions of group process, not
empirical studies conducted with control groups. According to
Kapur, Ramage and Walker (1986), since the 1960s analytic group work
with institutionalized populations has been de-emphasized. The analysis
of transference issues and in-depth emotional material is deemed
largely inappropriate and impractical. A study by Semmelhack,
Hazell, and Hoffman (2008) suggests outcomes to the contrary. They
found a significant decrease in anxiety and a trend toward decreased
depression after 30 weeks of group-as-a-whole work with severely
mentally-ill individuals residing in an inpatient setting. A
significant increase in cohesiveness after group-as-a-whole work under
these circumstances was also found (Semmelhack, Hazell, Ende, Hoffman,
& Gluzerman, 2009). MethodSetting
Experimental Group resided in a Fairweather Lodge located in a home in
a middle-class neighborhood. The home had four bedrooms, four
bathrooms, a living room area, TV room, large kitchen, dining room and
recreation area. The Control Group members resided in a typical
group home setting in the state where the study took place.Participants: Experimental Group
were nine residents in the Experimental Group, all of whom had been
given a major Axis I diagnosis according to the Diagnostic and
Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR)
(American Psychiatric Association, 2000). The population
ranged from 40 to 60 years of age. Three members were diagnosed as
having Paranoid Schizophrenia, two Major Depression, and four
Schizoaffective Disorder. None of the participants was diagnosed with
an Axis II disorder. All of them had experienced childhood trauma,
including sexual, emotional, or physical abuse, or neglect.
Additionally, all had made at least one suicide attempt. All
members had at least average intelligence, measured upon admittance
into the facility through the administration of a Kaufman Brief
Intelligence Test (K-BIT) (Kaufman & Kaufman, 1990).Participants: Control Group
ten members of the Control Group were matched with the Experimental
Group on gender, age and intelligence. Members of the Control
Group had similar Axis I diagnoses. They too showed an absence of
Axis II diagnoses. Like those in the Experimental Group, all
individuals had a history of suicide attempts and childhood
trauma. Control Group members were engaged in traditional group
home treatment, which included training or psychotherapy on an as
needed basis in addition to medication management.
sample consisted of nineteen clients (eight men and eleven
women). The Control Group included five men and five women, the
Experimental Group five men and four women. All participants were
European American. Instruments
Attitude Scale (GAS). The study measured cohesiveness using the Group
Attitude Scale (Evans & Jarvis, 1986). This questionnaire consists
of 20 self-report items. The items relate to several aspects of
cohesiveness, including attractiveness, belongingness, and well being.
They address the broadness of the concept of cohesiveness. The measure
requires the participants to respond to statements such as, "People in
my work group work together well," and, "I feel like I am really part
of my group" before and after the 16-week treatment period by placing
an "X" on a continuous scale labeled from 0 to 100. Members of
the Experimental and Control Groups were asked to indicate how they
felt about group membership (the group being the members of their group
In several studies of the original
Group Attitude Scale, the measure coefficient alpha has ranged from .90
to .97 at various points in the lives of groups studied. The validity
and reliability data obtained to date on the scale suggest that the
instrument has promise as a measure of sense of belonging to a group
(Evans & Jarvis, 1986). General Self-Efficacy
Scale (GSES). We measured self-efficacy using Jerusalem and
Schwarzer’s (1992) General Self-Efficacy Scale (GSES). The GSES
has been used to measure improvements over time in self-efficacy. It
was developed in Germany in 1979 by Matthias Jerusalem and Ralf
Schwarzer and was later revised and adapted to 26 languages (Jerusalem
& Schwarzer, 1992). The scale was originally created to assess a
general sense of perceived self-efficacy and to predict coping with
daily hassles, as well as to determine how one adapts to stressful life
events. The GSES was designed for the general adult population,
including individuals age twelve and up. The scale is
self-administered. It takes, on average, four minutes to administer. As
regards scoring, responses are made on a 4-point scale. After
administration, the responses to all 10 items are summed up and yield a
composite score ranging from 10 to 40. Higher scores indicate stronger
patient belief in self-efficacy.
The items on the GSES relate to
several aspects of self-efficacy, including belief in one’s capacity to
perform novel and difficult tasks and cope with adversity in various
areas of human functioning (Jerusalem & Schwarzer, 1992).
Perceived self-efficacy aids in goal setting and persistence when faced
with a setback. Each of the items on the scale points to successful
coping while attributing this success to one’s internal ability.
regard to the scale’s reliability, in samples from 23 nations
Cronbach’s alphas ranged from .76 to .90 (Jerusalem & Schwarzer,
1992). As regards validity, criterion-related validity has
been acknowledged in a variety of correlation studies where positive
coefficients were correlated with favorable emotions, dispositional
optimism, and work satisfaction, and negative coefficients were
correlated with depression, anxiety, and stress.
strengths of the GSES are that the measure has been used
internationally with success for two decades and that the measure is
suitable for a broad range of applications and populations, including
the elderly population, minorities, and others. (Jerusalem &
Schwarzer, 1992). The weakness of this measure is that it does
not necessarily assess behavioral change (Jerusalem & Schwarzer,
1992). Thus the measure may need to be used concurrently with an
additional one. Procedures
of study measures. Participants in the treatment group were given the
GAS (Evans & Jarvis, 1986) and the GSES (Jerusalem & Schwarzer,
1992) by a member of the Lodge staff before the group began (Time
1). The group ran for 16 weeks, at the conclusion of which
participants were again given the GAS and GSES (Time 2). A member of
the staff distributed the scales to group members immediately after the
end of the 16-week module. She read the explanation of each
measure written on the examination form with no other promoting of
which answer would be the correct or more appropriate one. She
collected the scales within two hours after the end of the group.
Members of the Control Group were assessed at the same two points by a
group home staff member, who distributed the measures following the
same protocol as with the Experimental Group.
are presented as mean and standard deviation. Baseline measures of
self-efficacy and cohesiveness before the start of treatment and at 8
and 16 weeks of treatment were compared between groups by unpaired
t-tests. Changes from baseline were determined in each group by
repeated measures ANOVA with Tukey tests used for post-hoc testing.Results
subjects completed the 16 week evaluation period in the Control Group
settings and nine subjects were evaluated under group-as-a-whole
treatment. There was no significant difference between the groups in
self-efficacy or cohesiveness determined as baseline measures before
the start of treatment (Table 1). (This equality at baseline was
particularly surprising since while Experimental Group members had only
recently met, Control Group members had resided together for thirteen
years.) However, the level of both self-efficacy and cohesiveness were
significantly higher for the modified Fairweather Lodge than for the
Control Group at 16 weeks of treatment.
Table 1. Agency
and cohesiveness during 16 weeks with control and Group-as-a-whole Lodges.
61.2 + 17.6
67.1 + 15.9
62.4 + 14.0
69.8 + 16.8
61.7 + 12.5
67.7 + 15.1
54.2 + 17.3
61.8 + 9.3
68.4 + 12.7
76.5 + 14.9
73.8 + 12.5*
83.2 + 12.8*
* = P < 0.05
compared to Control Group
Self-efficacy did not change in the Control Group, but
increased 45% in the Experimental Group from baseline to 16 weeks
(figure 1). The group-as-a-whole setting produced a 35% increase
in cohesiveness from baseline to 16 weeks of treatment (figure 2). In
contrast, the Control Group showed no significant change in
collected qualitative feedback from Experimental Group members suggests
the apparent utility of the modified Fairweather Lodge model, as well
as showing concretely some of its apparent effects. A few examples
suggest the tenor of a variety of comments. One member stated,”For the
first time in my life, I feel like part of a group.” Another one said,
“You know, we are a part of a team. We are all together and for better
or worse we can make things happen. I’m not alone. I have you guys
backing me.” A third member stated, “I need this group. I’ve never
before been understood as a person.” And another remarked, “Coming here
makes me feel more confident to face my day.”Discussion
findings suggest that individuals with chronic mental illness can
benefit from a group-as-a-whole treatment (in this case in a
Fairweather Lodge) that speaks to them as human beings who can learn
from their relationships. Despite society’s preoccupation with this
population’s having limitations, individuals with severe forms of
mental illness are human beings who know what it is like to feel
validated and connect with others. This is a major factor that
group-as-a-whole treatment brings to the table so that group members
can connect with each individual member as part of a larger community.
many approaches to individuals with mental illness minimize the
humanistic aspect with regard to symptom management. While
psycho-education plays an imperative role in allowing one to understand
and manage symptoms of mental illness, being able to connect with and
relate to others raises self-esteem and improves the ability to connect
with and reintegrate into society as a whole.
We need not only
to teach social skills and to encourage community, but to learn overall
how to create the conditions which foster human connectedness.
Group-as-a-whole work and the Fairweather Lodge are designed to do this.
addition to applying the group-as-a-whole treatment approach, we might
consider such questions as, how can we provide interpersonal direction?
What does it mean to be part of a group? What does it mean to be
validated and understood? And, how can we facilitate these crucial
individuals feel like part of a community, they can act more like one.
Group cohesion appears to increase self-efficacy in the world. The
group becomes internalized as a validating and a soothing
object--rather than an alienating one. This raises self-esteem while
reducing anxiety. Group cohesion, it appears, helps those with mental
illness become more effective actors in the social world. Study Limitations
to this study can be addressed in future research. Reactivity
within the repeated measures design may have been a weakness
influencing outcomes. For example, results may have been
influenced by the fact that members gained familiarity with the tests
given and an awareness that they were part of a study. Another
weakness is the small sample size because it may have attenuated our
ability to see significant differences between groups.
Additionally, the small sample size allowed for less reliable
measurement and could have affected the results by showing significance
where in reality there is none, or obscuring effects that were
present. Because the group of participants was not ethnically
diverse, the ability to generalize the results to diverse populations
is limited. Finally, as suggested in the “Results,” it may be necessary
to add an element of qualitative research to a study like this one in
order to establish more clearly the relationship between the concrete
Experimental Group process and the statistical results of the
society in the United States creates very limited housing options for
people with mental illness. The society places many such people in
long-term care centers with few options for treatment other than
medication management. Yet many of these individuals can develop the
skills they need to integrate into the community. Individuals with
severe mental illness need permanent housing options which, like the
modified Fairweather Lodge model, are designed to help bring about the
conditions required for client growth. Given the thoughtful
cultivation of community and skills, these individuals can learn to
meet the harsh demands of the social realities outside the group home.
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