Rutgers, The State University of New Jersey ICMS Training: Direct Care Series – Session 5

Department of Psychiatric Rehabilitation & Counseling Professions In previous sessions, you… 1.Identified the goal 2.Developed the rehabilitation plan (IRP) 3.Identified the knowledge, skills and resources (KSRA) needed to achieve the goal 1.Knowledge What a person needs to KNOW 2.Skills What a person needs to DO 3.Resources NOW WHAT? Skills teaching and Resource Development

Department of Psychiatric Rehabilitation & Counseling Professions Strengths Based Practices PsyR principle of “Strengths Focus” Let’s look at how perceptions change when we focus on strengths instead of illness and symptoms. Gestalt Project

Department of Psychiatric Rehabilitation & Counseling Professions Learning Objectives Understand the importance of support planning (developing skills and identifying resources) Identify reasons for skills deficits Describe a method for skills training Understand techniques for reinforcing skill attainment Develop a skills training lesson plan Practice skills training in a group format Identify resources

Department of Psychiatric Rehabilitation & Counseling Professions What contributes to successful community living? Supports or skills that you feel are important in the following areas: Housing Work Social School

Department of Psychiatric Rehabilitation & Counseling Professions Skill Development The aim of skill development is to promote community integration and restore the individuals to the maximum possible functioning level by improving social, interpersonal, problem-solving, coping and communication skills. Skills are the behaviors the person needs to be able to DO well in order to select, attain, and maintain his/her rehabilitation goal.

Department of Psychiatric Rehabilitation & Counseling Professions Why So Much Focus on Skills Training? Skill deficits interfere with successful community integration Skill deficits create barriers to achievement of rehabilitation goals (Bellack, 2004)

Department of Psychiatric Rehabilitation & Counseling Professions Sources of Skill Deficits Lack of acquisition in childhood, adolescence, early adulthood Lack of experience in community living Positive and negative symptoms Affective states (e.g. social anxiety) Attention, memory, problem solving Avoidance of community roles due to previous failure and/or stress associated with social demands Learned dependency (e.g., Social Security benefits) Environmental factors (lack of opportunities) Poor self esteem (Bellack, 2004)

Department of Psychiatric Rehabilitation & Counseling Professions Group Discussion What skills have been important to you in your life? –Living, learning, working, social Of those, which skills do you still need to work on? What help do you need to learn the skills? What supports/resources do you need?

Department of Psychiatric Rehabilitation & Counseling Professions What Types of Skills do Many Consumers Need to Learn? Social Living Learning Working Other?

Department of Psychiatric Rehabilitation & Counseling Professions How do we know what skills to work on? KSRA-see KSRA document –Identified the goal –Identified the knowledge, skills, and resources needed to obtain goal –Need to KNOW, need to DO, need to HAVE? Discussions –What have been problems in the past? Goal Related –What barriers are getting in the way of achieving goals? Observations See Knowledge, Skills, and Resources checklist Tools for Moving on Manual Tools for Moving on Manual (Tool 4: Skills and Supports)

Department of Psychiatric Rehabilitation & Counseling Professions Process of Skills Teaching (Tell, Show, Do) 1.Establish a rationale for learning the skill 2.Discuss the steps of the skill 3.Model the skill 4.Ask a person to try out the skill 5.Provide positive feedback 6.Provide corrective feedback 7.If needed, ask the person to try using the skill again 8.Provide additional feedback (positive & corrective) 9.If training in a group have other members do steps Encourage practice of the skill in natural environments (homework) (Bellack, 2004)

Department of Psychiatric Rehabilitation & Counseling Professions Activity Example – Skill Development Break down the steps to… –Identify a skill from one of the following categories –As a group, break down the steps to the identified skill

Department of Psychiatric Rehabilitation & Counseling Professions Skills Training Activity – In your same groups and using the same skill you just broke down, 1.Complete a lesson plan for teaching the skill 2.A person from each group will teach another group their skill 3.One member of the group will be the observer 4.Finally, come together to process and wrap up See the skills teaching template

Department of Psychiatric Rehabilitation & Counseling Professions Additional Techniques & Considerations Pacing to determine optimal number of sessions for a specific skillPrompting Supplementary modeling Discrimination modeling Role playingCoaching (Bellack, 2004)

Department of Psychiatric Rehabilitation & Counseling Professions Things to remember… Once you gain expertise in teaching skills to individuals or small groups you can teach most any skill, as long as you can: –Identify the behavioral steps of the skill –Model the skill If you can’t teach the skill, can you find someone that can OR are there resources that may help?

Department of Psychiatric Rehabilitation & Counseling Professions RESOURCE DEVELOPMENT

Department of Psychiatric Rehabilitation & Counseling Professions Resources The people, services, supports, monetary resources, entitlements, etc. the person needs to HAVE in order to select, attain, and maintain rehabilitation goal. What resources are available for the following –Housing –Work –School –Social

Department of Psychiatric Rehabilitation & Counseling Professions How do we know what resources people need? KSRA tells us what the person needs to know, do and have in order to select, attain, and maintain his/her goal. Finding Community Supports Checklist Remember to think of people, places, and things that people may need (both natural and paid)! See community supports checklist for examples

Department of Psychiatric Rehabilitation & Counseling Professions Small Group activity: Let’s look at Denise Step 1: Based on what you know from the scenario: –What are her strengths? –What is her goal? –What skills does she need to DO? –What resources does she need to HAVE to achieve this goal? Step 2: Now that we know this information, what would you do next? –How would help Denise learn the skills or access these resources?

Department of Psychiatric Rehabilitation & Counseling Professions Service Coordination How do you coordinate services to make sure Denise’s needs are met? Now, how do you involve Denise in this process? –What are some specific strategies that you would use?

Department of Psychiatric Rehabilitation & Counseling Professions Comprehensive Service Delivery Looking at the whole person and each wellness domain Not just problem focused or illness related but GOAL related Eight dimensions of wellness –Addressing ALL of these areas Strengths Based Case Management—touch on all of these domains

Department of Psychiatric Rehabilitation & Counseling Professions (Swarbrick, 2012)

Department of Psychiatric Rehabilitation & Counseling Professions Summary KSR Assessment Skills Teaching Resource Development Service Coordination

Department of Psychiatric Rehabilitation & Counseling Professions References Bandura, A. (1977). Social learning theory. Englewood Cliffs, N.J.: Prentice-Hall. Bellack, A.S., Mueser, K.T., Gingerich, S. & Agresta, J. (2004). Social Skills Training for Schizophrenia, 2 nd Edition. New York: Guildford Press. Psychiatric Rehabilitation Association. (2016). Core principles and values. Retrieved from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4),