Reference: Robert Paul Liberman, M.D., Charles J. Wallace, Ph.D., Gayla Blackwell, R.N., M.S.W., Alex Kopelowicz, M.D., Jerome V. Vaccaro, M.D. and Jim Mintz, Ph.D. Skills Training Versus Psychosocial Occupational Therapy for Persons With Persistent Schizophrenia. Am J Psychiatry 155:1087-1091, August 1998
OBJECTIVE:The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals.
METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments.
RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning.
CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.
Psychosocial Treatment Conditions
Psychosocial occupational therapy was led by three certified occupational therapists and comprised expressive, artistic, and recreational activities that mediated supportive therapy. Patients participated individually and in groups, with encouragement by the therapists to individualize their interests and abilities through arts and crafts, discussion of feelings, and articulation of personal goals.
The skills training was conducted by an occupational therapist and three paraprofessionals who took turns in leading four modules of the UCLA Social and Independent Living Skills Program—basic conversation, recreation for leisure, medication management, and symptom management.
1. Medication Management Module
Identifying benefits of antipsychotic medication
Self-administration and evaluation of medication
Serious and mild side effects of antipsychotic medication
Negatiating medication issues with your doctor
Benefits of long-acting, injectable medication
2. Symptom Management Module
Identifying warning signs of relapse
Developing a relapse prevention plan
Coping with persisting psychotic symptoms
Avoiding street drugs and alcohol
3. Recreation for Leisure Module
Identifying benefits of recreational activities
Getting information about recreational activities
Finding out what's needed for a recreational activity
Evaluating and maintaining a recreational activity
4. Basic Conversation Skills Module
Active listening skills
Putting it all together
Each module consisted of a trainer's manual, a participant's workbook, and a demonstration video; these are described in detail elsewhere (Liberman RP, Corrigan PW: Designing new psychosocial treatments for schizophrenia. Psychiatry 1993; 56:238–248).
Each module consisted of segments or "skill areas," and each skill area included specific educational objectives. For example, in the medication management module, the skill area on "identifying benefits of antipsychotic medication" focused on teaching participants to make polite requests of their doctors regarding the type, dose, and benefits of medication.