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Introduction

Skills training is a therapy technique used by healthcare professionals to help individuals learn new skills that are involved in social interactions. In the specific population of those who are homeless, evidence shows that social networks play an important role in mental well being (Gray, Shaffer, Nelson, Shaffer, 2018). The new skills learned are practiced in steps and repeated to instill new knowledge. Skills such as taking turns, joint attention, eye contact, nonverbal communication, and language are needed for effective interpersonal relationships (Case-Smith & Arbesman, 2008). Occupational therapists can use skills training to help adults and children with mental illnesses who struggle with behavioral issues during social interactions. With the implementation of therapy and repetition of learning, clients can benefit from skills training sessions.

Theory

The social learning theory suggests that an individual can change their own behavior through observing the positive behaviors of others, accessing reinforcement, and having positive outcome expectancies (Brown, 2012). During social skills training, occupational therapy practitioners will provide opportunities for the client to problem solve and engage in social role play to facilitate learning social skills by incorporating the social learning theory. The goal would be for the client to engage in appropriate social interactions.

Evidence

A prospective review observed significant positive change in social network quality over time in homeless adults completing a life skills program (Gray, P. Shaffer, Nelson, & H. Shaffer, 2015). They examined changes in social network quality, size, and composition, such as fewer members of their network who abuse alcohol.

Case Study

Fitzroy Frederick is a 37 year old homeless man living with schizophrenia in New York City.  He was provided housing and an employment opportunity in The Fountain House, a program designed to provide assistance to individuals with mental illness. While adhering to Fitzroy’s prescribed medication, he successfully lived with roommates and began work training.  Shortly after, however, he reported the use of an herbal remedy, described as a “cure” for schizophrenia, was a better alternative to taking his prescribed medications to manage his symptoms. Consequently, Fitzroy began to engage in aggressive behaviors toward his roommates and experienced increased difficulties with work training tasks. Fitzroy was referred to an occupational therapist at The Fountain House to address his aggressive behaviors and limitations with social participation.

Intervention Plan

Problem Statement

Fitzroy demonstrates a lack of ability to control aggressive behaviors, these deficits are limiting Fitzroy’s participation in social relationships.

Long Term Goals

1. Fitzroy will engage in 3 non-aggressive exchanges with peers for social participation within 4 weeks
2. Fitzroy will utilize one relaxation technique when confronted with a trigger to increase social participation in 4 weeks.

Short Term Goals

1. Fitzroy will identify 3 coping strategies to utilize when feeling aggressive towards others to increase social participation within 2 weeks.
2. Fitzroy will identify 2 triggers to aggressive behaviors to increase social participation within 2 weeks.

Intervention Format

Individual

Setting

Fitzroy will attend one-on-one sessions with the occupational therapist at the Fountain House for 40 minutes 4x per week.

Supplies

• Paper and pen for documenting

Agenda

• Meet Fitzroy & develop rapport (3 min)
• Assess Fitzroy’s readiness to participate (2 min)
• Educate and model appropriate social skills (10 min)
• Engage in role playing activity (15 min)
  • Provide constructive feedback (5 min)
• Provide a summary of the discussion and activity (5 min)

Documentation

S: Client stated “I hate when my roommates disagree with me.” Client reported having argued with his roommates 3 times in the past week.

O: Client participated in a 40-minute individual session at the Fountain House focusing on social skills using a social learning theory approach. During the role play activity, the client was able to identify one trigger to his aggressive outbursts. Client was initially apprehensive to participate in the role play activity, and was unable to generalize the skills provided during the educational session to the role play scenario. He required 3 verbal cues and 1 demonstration to apply an appropriate response in the social interaction.

A: Client’s difficulty responding appropriately to the therapist in a role play scenario demonstrates deficits in social skills, secondary to his diagnosis of schizophrenia and lack of ability to control aggressive behaviors. Client’s inability to identify more than 1 tigger to emotional outbursts reflects his lack of insight.

P: Client would benefit from 40 min OT sessions 4x/week to provide additional social skills training. Target insight in trigger awareness and coping strategies to facilitate prevention of aggressive outbursts toward others.

References

Brown, C. (2012). Occupational therapy practice guidelines for adults with serious mental illness. Bethesda, MD: AOTA Press. ISBN-13: 978-1-56900-331-2

Gray H, Shaffer P, Nelson S, Shaffer H. Changing Social Networks Among Homeless Individuals: A Prospective Evaluation of a Job- and Life-Skills Training Program. Community Mental Health Journal [serial online]. October 2016;52(7):799-808. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 26, 2018.