The Center

Psychiatric Rehabilitation – Achieving a Valued Role: Skill Development

Updated:  June 21, 2006

Often, mental health programs dedicated to helping individuals realize their goals begin the process of rehabilitation at the “achieving” phase, meaning the point of helping someone to get a job, to obtain a GED or to acquire housing. In the Psychiatric Rehabilitation Approach however, many activities precede this outcome of goal attainment. As described in past articles in this series, the consumer and practitioner have worked through a process of Assessing Readiness, Developing Readiness if needed, and Choosing a Valued Role should the person be uncertain about what they want to do. Time and effort has been invested to understand the person’s need for change, to develop confidence and motivational readiness for change, to enhance one’s understanding of personal values and preferences, and to increase an awareness of available options from which a choice is made. The choice that a recipient makes is an informed choice when it is based upon an expanded level of self and environmental awareness and an understanding of the implications of one decision over another. It is at this point in the Psychiatric Rehabilitation Approach that the process of “achieving” begins.

Experience has shown that three elements correlate highly with rehabilitation outcomes: skills, supports and the extent to which an environment is preferred. While the process of Choosing a Valued Role enables the recipient to use personal criteria to seek out a preferred choice, the next step of Achieving a Valued Role involves determining and responding to the behaviors that are required in an environment by focusing on skills and supports. Knowing the skills and supports both needed by the environment to be successful and desired by the person to be satisfied significantly increases the chance of a positive outcome. This article will focus on the process of defining, evaluating and developing skills.

Research over the past 20 years has shown that people can learn skills, and the greater detail in which we teach a skill, the better the application. If skill use is a solution to something that is needed and very much desired by an individual, the person will be much more invested and motivated in learning how to apply a skill. Usually, the challenge for recipients is understanding when a skill needs to be used, with whom, why, and in which circumstances. Much of the work in skill development therefore entails this type of assistance, concentrating on the supports needed to address barriers to skill use.

Typically, Achieving a Valued Role through skill evaluation and development begins with finding out what an individual needs to do or how they need to behave in a specific environment. Two sources of information are explored for this purpose, the environment and the individual. The chosen environment dictates explicit and implicit requirements that are needed, and the recipient identifies desired behaviors based on past experiences that s/he wants to resolve in a more satisfactorily. From a list of needed and desired behaviors, the recipient and the practitioner extract critical skills that are pivotal in both acquiring and sustaining a goal. Identifying critical skills is an analytical process that takes time and a thorough understanding of expectations at the environment including determining the consequences of skills not performed and the frequency with which skills are needed. A challenge inherent in this process is understanding that many skills are beneficial and enriching while only a handful are critical and may ‘make or break’ a situation. Once critical skills are identified and defined in a way which is meaningful to the recipient an assessment is undertaken to determine if the person can perform the skill at the needed level. Based on the results of this functional assessment, the intervention of either skills programming or direct skills teaching is selected. Direct skills teaching is a structured and detailed method that includes developing comprehensive lesson plans reflecting the many discrete behaviors of a skill and teaching the skill through a sequence of instructions spanning the ‘Tell-Show-Do-Feedback’ method. More often than not skills programming, or a system for identifying barriers to successful skill performance and the use of supports to eliminate those barriers, is the intervention used. Because supports are just as important as skills for persons trying to reach and sustain their goals, the next and last article in this series will focus on Achieving a Valued Role through supports.