Community Support Services Training Direct Care Series – Session 7 Zakia Clay, MSW, LCSW Zakia.Clay@shrp.rutgers.edu Ann Reilly, MA, LSW, CPRP Reillya2@shrp.rutgers.edu Anthony Zazzarino, MA, LPC, CPRP Anthony.Zazzarino@shrp.rutgers.edu

Review from Session 6

Learning Objectives 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

DMHAS Expectations 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 Reimbursable activities are those that involve teaching the consumer various physical, cognitive/intellectual and behavioral skills related to identified goals. This leads to increased competence and proficiency in living independently in the community (Larosiliere, 2011)

Skills Training at a Minimum… Discussions with the consumer about the skill to be learned Benefits of learning the skill Breaking the skill down into its component parts Showing examples of how the skill is correctly used or performed Arranging opportunities to practice skill use in the community setting Providing evaluation and feedback (Larosiliere, 2011)

Why So Much Focus on Skills Training? Many people living with chronic mental illness lack critical skills Skill deficits interfere with successful community integration Skill deficits create barriers to achievement of rehabilitation goals Skill deficits may result in ongoing dependency on staff (Bellack, 2004)

Sources of Skill Deficits Lack of acquisition in childhood, adolescence, early adulthood Lack of practice in “normal” settings Positive and negatives symptoms of schizophrenia Affective states (e.g. social anxiety) Neurobiological factors (attention, memory, problem solving) Motivational factors (avoidance due to previous failure and/or stress associated with social demands) Learned dependency Environmental factors (lack of opportunities) Poor self esteem (Bellack, 2004)

Small Group Discussion What skills have been important to you in your life? What skills do you still need to learn to enhance your community integration? Of those, which skills do you still need to work on? What help do you need to learn the skills?

What Types of Skills do Many Consumers Need to Learn? Social ADL/Independent Living Illness Management Vocational Academics Other?

Bellack’s social skill categories Basic Social Skills Conversational Skills Assertiveness Skills Conflict Management Skills Communal Living Skills Friendship and Dating Skills Health Maintenance Skills Vocational/Work Skills Coping Skills for Drug & Alcohol Use

Research Supports This… 5 of Bandura’s principles are incorporated into social skills training: Modeling, Reinforcement, Shaping, Overlearning, and Generalization Social behaviors are acquired through both observing others’ actions & the consequences of one’s own actions Chronic mental illness can interfere with natural development and maintenance of these skills (Bellack, 2004)

Process of Skills Teaching (Tell, Show, Do) Establish a rationale for learning the skill Discuss the steps of the skill Model the skill Ask a person to try out the skill Provide positive feedback Provide corrective feedback If needed, ask the person to try using the skill again Provide additional feedback (positive & corrective) If training in a group have other members do steps 4-8 Encourage practice of the skill in natural environments (homework) (Bellack, 2004)

Activity Example – How to Do Laundry Break down the steps on to do laundry

Techniques for Reinforcing Skills Always start with a review of homework Provide positive reinforcement for efforts to practice the skill after learning Engage each member in role plays based on homework or other real life situations Collaborate on additional, individually tailored, homework assignments (Bellack, 2004)

Additional Techniques & Considerations Pacing to determining optimal number of sessions for a specific skill Prompting Supplementary modeling Discrimination modeling Role playing Coaching (Bellack, 2004)

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?

Skills Training Activity – Trainers will count the room off into 4 groups and assign the skill that will be taught. Identify a recorder and as a group complete a lesson plan for teaching the skill group One from each group will teach another group their skill One member of the group will be the observer Come together to process and wrap up

Process of Skill Teaching (Tell, Show, Do) Establish a rationale for learning the skill Discuss the steps of the skill Model the skill Ask a person to try out the skill Provide positive feedback Provide corrective feedback If needed, ask the person to try using the skill again Provide additional feedback (positive & corrective) If training in a group have other members do steps 4-8 Encourage practice of the skill in natural environments (homework) (Bellack, 2004)

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, 2nd Edition. New York: Guildford Press. Larosiliere, V (2011). Community Support Services [memo]. Retrieved from http://www.state.nj.us/humanservices/dmhs/info/CSS_Notice_t o_providers.pdf.