Homework Assistance

The Im por tance of Pos i tive Cli ent-Staff So cial In ter ac tions in In pa tient Psy chi at ric Re ha bil i ta tion Programs

Danielle R. Critten Jill L. Bezyak Juliet H. Fried

Ab stract -- So cial sup port has re ceived much at ten tion and em pir i cal sup port as be ing a key com po nent of the psy chi at ric re ha bil i ta tion of in di vid u als with se ri ous men tal ill ness (SMI). So cial dys func tion is of ten a de fin ing char ac ter is tic of SMI, and in ter ven tions tar get ing so cial def i cits help to im prove cli ent out comes. The pro vi sion of so cial skills train ing and psychoeducation to im prove so cial in ter ac tions and cli ent knowl edge of their ill ness and treat ment op tions is vi tal in psy chi at ric re ha bil i ta tion. Since most pa tient in ter ac tions in an in pa tient fa cil ity are with staff mem bers and oth ers with SMI, staff mem bers must be mind ful of the na ture of in di vid u als’ ill nesses, as well as their style of com mu ni ca tion with the cli ents they serve as these are closely as so ci ated with re ha bil i ta tion out comes. Staff mem bers also are in charge of ed u cat ing in di vid u als about their ill ness and treat ment op tions, and they should be knowl edge able about the in for ma tion they are im part ing. Rec om men da tions for ap proaches to better pre pare in pa tient staff mem bers to work with per sons with SMI are pro - vided. Keywords: so cial sup port, in pa tient psy chi at ric re ha bil i ta tion, se vere men tal ill ness, train ing

S o cial sup port has gained much at ten tion as a key com po nent in the psy chi at ric re ha bil i ta tion of in di vid u als with se ri ous men tal ill ness (SMI). One of

the ma jor as pects of SMI is the in abil ity to de velop and main tain so cial re la tion ships. De vel op ing a treat ment plan that ac tively in volves peers, fam ily mem bers, and treat ment team mem bers may be as ben e fi cial to the re cov ery of an in di vid ual with SMI as pharmotherapeutic mea sures. Re search pro vides a sig nif i cant amount of in for ma tion re gard ing the im pact of so cial sup port on re ha bil i ta tion out comes such as cop ing strat e gies, over all life sat is fac tion, em ploy ment, ad just ment to dis abil ity, treat ment com pli ance, and re cov ery (Cor ri gan & Phelan, 2004; Chou & Chronister, 2012; Rogers, Anthony, & Lyass, 2004; McCorkle, Rogers, Dunn, Lyass & Wan, 2008).

Com po nents of so cial sup port in ter ven tions that have been found most ef fec tive in re ha bil i ta tion set tings are psychoeducation for in di vid u als and fam ily mem bers, com - mu nity-based in ter ven tions, so cial skills train ing, and a work ing ther a peu tic al li ance (Tay lor et al., 2009). Ad di -

tion ally, a vi tal pre dic tor of pa tient out comes is the so cial sup port re sult ing from a strong ther a peu tic al li ance be - tween treat ment team staff members and individuals receiving treatment.

The fo cus of the pres ent lit er a ture re view is the so - cial as pects of psy chi at ric re ha bil i ta tion pro grams and im - prove ments needed to achieve the best out comes for in di vid u als with SMI. Spe cif i cally, the re view ex plores how staff mem bers (e.g. re ha bil i ta tion work ers), who are vi tal parts of the psy chi at ric re ha bil i ta tion pro cess, can be better pre pared to work with in di vid u als with SMI to pro - mote op ti mal re cov ery. The lit er a ture re view fo cuses on the na ture of so cial sup port in ter ven tions in psy chi at ric re ha bil - i ta tion and em pir i cal sup port for these in ter ven tions. Con - sid er ations on how to best im ple ment these interventions, with attention to the training of staff members, are provided.

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Volume 44, Number 2, Summer 2013

Back ground: So cial Sup port in Psy chi at ric Re ha bil i ta tion

So cial sup port among in di vid u als with SMI con - trib utes pos i tively to re cov ery and over all qual ity of life for those par tic i pat ing in psy chi at ric re ha bil i ta tion pro grams, and it de creases rates of rehospitalization (Cor ri gan & Phelan, 2004; Rog ers et al., 2004; McCorkle et al., 2008; Chou & Chronister, 2012). So cial sup port is a multi-fac - eted, com plex con struct that in cludes both the num ber of sup ports an in di vid ual has and the per ceived qual ity of these sup ports (Cor ri gan & Phelan, 2004). More spe cif i - cally, both ob jec tive (num ber of sup ports) and sub jec tive (qual ity of sup ports) have been eval u ated to de ter mine if they con trib ute to the pro cess of re cov ery. Re sults in di cate that both ob jec tive and sub jec tive mea sures of so cial sup - port are sig nif i cantly associated with recovery among individuals with SMI (Corrigan & Phelan, 2004).

In ad di tion, Chou and Chronister (2012) ex am ined four char ac ter is tics of so cial ties (i.e., per ceived emo tional sup port, tan gi ble sup port, so cial net work ori en ta tion, and neg a tive so cial ex change) to better un der stand how they re - late to spe cific re ha bil i ta tion out comes (qual ity of life, men - tal health re cov ery, and lone li ness). The au thors found that an in crease in per ceived emo tional sup port pre dicts lower lev els of lone li ness, and in creased tan gi ble sup port pre dicts higher lev els of re cov ery for this pop u la tion (Chou & Chronister, 2012). This ev i dence pro vides a strong foun da - tion for the vi tal role of social support within the rehabilitation context.

The com po nents of so cial sup port and what makes it so ef fec tive in re ha bil i ta tion have been an on go ing topic of dis cus sion among pro fes sion als in the field. One area of in ter est is the buff er ing hy poth e sis, which sug gests so cial sup port pro tects in di vid u als from the po ten tial harm ful in - flu ence of stress ful events. An other model pro poses the re - sources pro vided from so cial sup port have ben e fi cial ef fects re gard less of the amount of stress ex pe ri enced (Rog - ers et al., 2004). Per cep tions of so cial sup port can re duce stress by chang ing the way one thinks about life stress ors, chang ing cop ing styles, in flu enc ing how one views self-ef - fi cacy, or chang ing prob lem-solv ing be hav iors (Rog ers et al., 2004). Taken to gether, the ef fects of pos i tive per cep - tions of so cial sup port for an in di vid ual with SMI are ex - tremely ben e fi cial for rehabilitation outcomes and the overall well-being of the individual.

Psychosocial In ter ven tions In cor po rat ing So cial Sup port

Fam ily Psychoeducation

Fam ily psychoeducation pro vides a means to en - cour age so cial sup port from fam ily mem bers. Psychoeducation re sults in in creased treat ment com pli ance, lower rates of re lapse, and an over all im proved psy cho log i - cal state (Bäuml, Froböse, Kraemer, Rentrop, &

Pitschel-Walz, 2006). In clud ing fam ily mem bers in treat - ment can be ben e fi cial to un der stand ing a SMI, and it can im prove sup port ties. When fam ily mem bers better un der - stand the na ture of the dis ease, they are equipped to pro vide emo tional and tan gi ble sup port to their loved one and re in - force the recovery process (Bäuml et al., 2006).

One as pect of psychoeducation in re ha bil i ta tion pro grams is the role of the staff mem ber pro vid ing in for ma - tion and guid ance to cli ents and fam i lies about the na ture of the ill ness and re lated op tions for treat ment. A pre lim i nary ex pla na tion to an in di vid ual with SMI must be pro vided by an em pa thetic staff mem ber in or der to min i mize any feel - ings of un cer tainty and de mor al iza tion (Bäuml et al., 2006). The qual ity of the ther a peu tic re la tion ship when in ter act ing with in di vid u als in both acute and postacute stages of schizo phre nia is of pri mary im por tance (Bäuml et al., 2006). This im plies that not only does psychoeducation pro vide vi tal sup port from fam ily mem bers, but it also pro - vides pos i tive sup port from in pa tient staff in volved in treat - ment. As a re sult, staff must be prop erly trained and pre pared to im part psychoeducation to fa cil i tate the re cov - ery pro cess. Staff mem bers must be able to trans late tech ni - cal jar gon into lan guage that can be eas ily un der stood in or der to help in di vid u als be come ex perts about their ill ness (Bäuml et al., 2006). Care ful trans la tion of med i cal terminology is especially important among individuals for whom disorganized thinking may be involved.

Al though psychoeducation has ex tremely ben e fi - cial ef fects on cli ent out comes, it is not reg u larly of fered in in pa tient fa cil i ties (Tay lor et al., 2009). Re search clearly in di cates a lack of re sources and train ing in psychoeducation among in pa tient staff (Tay lor et al., 2009). Since psychoeducation pro motes re cov ery of in di - vid u als with SMI (Bäuml et al., 2006), it is vi tal that re ha - bil i ta tion pro grams be gin of fer ing this in ter ven tion reg u larly, as well as en sur ing that all in pa tient staff are properly equipped to provide the intervention.

Com mu nity-Based In ter ven tions

In many larger psy chi at ric in pa tient fa cil i ties, dif fi - cul ties arise when care ceases to be in di vid u al ized and lev - els of re stric tion are high com pared to the free dom and more per son al ized care of ten pro vided in com mu nity set - tings. Ev i dence sug gests a ma jor ity of in di vid u als in in pa - tient set tings pre fer liv ing in com mu nity set tings rather than hos pi tal set tings, which are as so ci ated with better cli ent out comes (Tay lor et al., 2009). The man age ment of med i - ca tion, skills train ing, and so cial sup port is greatly im - proved when ser vices are pro vided in com mu nity set tings where personal goals are more intimately experienced (Corrigan, 2002).

As ser tive Com mu nity Treat ment (ACT) is an ex - am ple of a com mu nity-based in ter ven tion that em pow ers the de ci sion mak ing of cli ents us ing a team-based ap proach (Gold et al., 2003). A strong work ing al li ance be tween staff mem bers and in di vid u als with SMI is a ma jor as pect in ACT in ter ven tions, and it is stressed that cli ent-cen tered

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Journal of Applied Rehabilitation Counseling

care re sults in in creased per ceived lev els of sup port from staff mem bers. This model works col labor atively with in di - vid u als’ fam i lies and other peo ple in their so cial net works to lessen sources of so cial stress and strengthen at tach ments to social supports (Gold et al., 2003).

ACT en hances the qual ity of so cial sup ports in the lives of in di vid u als with SMI not only from fam ily and friends, but also from staff mem bers. This type of in di vid u - al ized sup port and col lab o ra tive work ing al li ance be tween staff mem bers and in di vid u als with SMI should not be ig - nored, even in hos pi tal-based treat ment fa cil i ties. Stud ies in di cate com mu nity res i den tial fa cil i ties are more facilitative of pa tient au ton omy and have more pos i tive pa - tient-staff re la tion ships (Tay lor et al., 2009). The ba sic ten - ets of the ACT model can be in te grated into in pa tient set tings. Im por tant as pects in clude em pha sis on con sumer choice, em pow er ment of in di vid u als through col lab o ra tive de ci sion-mak ing, lower lev els of re stric tion and, most important, a strong working alliance between inpatient staff members and clients.

The In di vid ual Place ment and Sup port (IPS) model is sim i lar to the ACT model, with con cepts such as in te - grated re ha bil i ta tion ser vices and at ten tion to con sumer pref er ences (Bond, 1998). A ma jor prin ci ple of the IPS model is the in te gra tion of vo ca tional re ha bil i ta tion and men tal health ser vices, which has been found to im prove ac cess and re ten tion in vo ca tional pro grams and to in crease em ploy ment out comes for in di vid u als with SMI (Bond, 1998). Com mu nity in te gra tion should be a ma jor goal of psy chi at ric re ha bil i ta tion pro grams. Even in in pa tient care, there should be ef forts made to prop erly in form cli ents of pos si ble vo ca tional goals and ex pec ta tions. Bond (1998) sug gested that of fer ing cli ents an in for ma tional group in or - der to ex plain vo ca tional pro gram op tions al lows cli ents to make in formed choices about their goals. Col lab o ra tion be - tween vo ca tional re ha bil i ta tion and in pa tient staff can en - sure that cli ents re ceive op por tu ni ties for com mu nity in te gra tion. In pa tient pro grams should strive to cross-train their staff to provide vocational training programs and make connections with employment specialists.

So cial Skills Train ing

So cial sup port is vi tal in the re cov ery pro cess for in di vid u als with SMI. So cial skills train ing can greatly in - crease the like li hood of cre at ing and main tain ing ben e fi cial sources of sup port. Of the three best sup ported strat e gies for psy chi at ric re ha bil i ta tion of in di vid u als with SMI (cog - ni tive be hav ior ther apy, cog ni tive remediation, and so cial skills train ing), so cial skills train ing has re ceived the stron - gest em pir i cal sup port and is con sid ered an ev i dence-based treat ment (Bellack, 2004). Those who par tic i pate in so cial skills train ing are hos pi tal ized less, dem on strate fewer psy - chotic symp toms, and have a better qual ity of life af ter ac - quir ing these skills (Cor ri gan, 1997). Fre quently, in di vid u als with SMI ex pe ri ence grad ual iso la tion, re mov - ing them from so cial groups and de creas ing op por tu ni ties to par tic i pate in typ i cal so cial roles. In pa tient set tings may

fur ther limit so cial con tacts to other in di vid u als with SMI and men tal health care pro vid ers (Bellack, 2004). Thus, it is more important that those social ties to staff members are based on trust and collaboration.

The so cial skills model is based upon the un der ly - ing prin ci ple that so cial def i cits are a de fin ing char ac ter is tic of SMI, and so cial func tion ing is pre dic tive of the out come of the ill ness (Bellack, 2004). So cial com pe tence is based on three com po nent skills: so cial per cep tion (re ceiv ing skills), so cial cog ni tion (pro cess ing skills), and be hav ioral re hearsal (ex pres sive skills). Re search sug gests that all of these skills can be learned (Bellack, 2004). In pa tient staff have op por tu ni ties and re spon si bil ity for teach ing and mod - el ing these skills in a struc tured manner during daily interactions with clients.

In pa tient staff mem bers need to ef fec tively pro vide so cial skills train ing to cli ents in or der to in crease so cial con fi dence when re turn ing to the com mu nity and to build pos i tive re la tion ships while re ceiv ing treat ment. A pri mary com po nent of so cial skills train ing is be hav ior mod el ing of staff and be hav ior re hearsal of cli ents through sim u lated con ver sa tions and role play. Staff mem bers pro vide feed - back and pos i tive re in force ment along with help ful sug ges - tions for im prove ment (Bellack, 2004). The more pre pared staff is to pro vide this train ing, as well as the more knowl - edge able they are about the ten ets of the so cial skills model, the better the out comes of the in ter ven tion. So cial in ter ac - tions are im por tant dur ing in pa tient treat ment and need to be treated as such by all staff mem bers. Ev ery so cial in ter - ac tion be tween cli ents and staff in in pa tient set tings is an opportunity to teach and model social skills.

Ther a peu tic Al li ance

Cli ent sat is fac tion that re sults from a strong ther a - peu tic al li ance in psy chi at ric pro grams is con du cive to pos i - tive re ha bil i ta tion out comes. The ther a peu tic re la tion ship be tween pro vid ers and in di vid u als with SMI has been found to be one of the stron gest pre dic tors of pos i tive out - comes (Tay lor et al., 2009). Com mu nity-based men tal health fa cil i ties that have a co he sive, pos i tive so cial cli - mate, along with staff mem bers who en cour age cli ent in de - pend ence and in volve ment in de ci sion mak ing, are as so ci ated with greater cli ent sat is fac tion and better out - comes (Tay lor et al., 2009). Treat ment part ner ships that in - clude staff en dorse ment of re cov ery, rather than the as sump tion of a poor prog no sis, re sult in em pow er ment for in di vid u als with SMI, lead ing to im proved de ci sion-mak - ing skills (Cor ri gan, 2002). Staff mem bers pro vid ing care to those with SMI in in pa tient psy chi at ric set tings must be properly prepared and aware of their influential role in the lives of the individuals they serve.

Treat ment in in pa tient care re quires a mu tu ally re - spect ful and op ti mis tic col lab o ra tion be tween cli ents and staff mem bers. Hav ing this pos i tive col lab o ra tion re sults in cli ent em pow er ment, and it pro motes ben e fi cial treat ment and in creased suc cess in symp tom con trol (Cor ri gan, 2002). The qual ity of the ther a peu tic re la tion ship is in flu -

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enced by many fac tors in clud ing a fo cus on re cov ery rather than poor prog no sis, col lab o ra tive treat ment rather than co - er cive treat ment, and stigma-free at ti tudes and be hav iors (Cor ri gan, 2002). En dors ing pos i tive, col lab o ra tive at ti - tudes and be hav iors with clients in inpatient settings increases positive treatment outcomes.

The pro fes sional back ground of the staff can also in flu ence the re la tion ship, in clud ing pre vi ous train ing, in - ter ven tions pro vided, and psy cho log i cal the o ries sup port - ing prac tice. Other fac tors in clude the likeability of the staff, amount of time staff spends with cli ents, and staff per - cep tions of cli ents (Tay lor et al., 2009). Staff per cep tions of their re la tion ship with in di vid u als with SMI are more strongly cor re lated with cli ent out comes than the cli ent’s per cep tions of these re la tion ships (Tay lor et al., 2009). Psy chi at ric re ha bil i ta tion staff should pro vide cli ent-cen - tered care with a fo cus on what is im por tant to the cli ent, rather than a fo cus solely on what is im por tant to the clin i cal team. Staff should also pro vide cli ents and their fam i lies with as much in for ma tion as pos si ble to promote client involvement in the treatment process (Taylor et al., 2009).

Cli ent-Staff Com mu ni ca tion

Dif fi cul ties in com mu ni ca tion by in pa tient staff with cli ents, fam i lies, and treat ment teams are a main source of work stress for psy chi at ric staff that can hin der the re ha - bil i ta tion pro cess (Arranz, Ulla, Ramos, Rincon, & Lopez-Fando, 2005). Al though so cial in ter ac tion be tween staff and in di vid u als with SMI is pos i tively re lated to re ha - bil i ta tion out comes, many in pa tient staff mem bers have train ing and ed u ca tion that are med i cal in na ture and, in many cases, do not fo cus on ef fec tive in ter ac tion and com - mu ni ca tion skills (Arranz et al., 2005). Train ing pro grams for in pa tient staff to en hance com mu ni ca tion skills and gain in sight into the im por tance of em pa thy and advocacy can have a beneficial role in the outcomes for clients.

In an ef fort to di min ish com mu ni ca tion dif fi cul ties, Arranz et al. (2005) de vel oped a coun sel ing train ing pro - gram in a uni ver sity hos pi tal. The ef fec tive ness of this pro - gram was eval u ated to de ter mine if the train ing in creased the qual ity of so cial in ter ac tions be tween staff and cli ents, fam i lies, and other staff mem bers (Arranz et al., 2005). This pro gram in cluded a thor ough for mu la tion of con cepts, at ti tudes, and skills in ef fec tive com mu ni ca tion, self-reg u - la tory tech niques, prob lem solv ing, and emo tional sup port. Re sults in di cated the pro gram was ef fec tive in di min ish ing in ter ac tion dif fi cul ties be tween staff and cli ents. How ever, those who par tic i pated in the train ing pro gram may have had per son al ity char ac ter is tics that caused them to be more mo ti vated and in volved in these in ter ac tions in the first place. De spite this lim i ta tion, an attempt to implement a similar program in an inpatient setting may prove beneficial.

Lack of knowl edge about the na ture of SMI also af - fects the ther a peu tic re la tion ship, as well as com mu ni ca tion be tween cli ents and staff. Staff at ti tudes about the na ture of SMI can cre ate bar ri ers to ef fec tive em pa thetic in ter ac tions

and the emo tional sup port cru cial to out comes. Endley and Berry (2011) eval u ated the ef fec tive ness of a staff train ing pro gram that im parted in for ma tion about the na ture and im - por tance of ex pressed emo tion (EE) in in di vid u als di ag - nosed with schizo phre nia. High EE char ac ter is tics in clude be ing hos tile, less tol er ant of pa tients, frus trated, and re - gard ing be hav ioral dif fi cul ties as be ing out of cli ents’ con - trol. Low EE char ac ter is tics of staff pro mote the ther a peu tic al li ance. These char ac ter is tics also in clude be - ing able to con trol emo tions when con fronted with difficult behavior and seeing patients as independent (Endley & Berry, 2011).

Endley and Berry (2011) aimed to im prove cli - ent-staff re la tion ships by cre at ing a train ing ses sion that stressed cli ent symp toms and chal leng ing be hav iors are as - so ci ated with the ill ness or en vi ron ment, and blame should not be placed on in di vid u als. Role play was a tech nique used to al low staff to ex pe ri ence high and low EE from dif - fer ent per spec tives. As pre dicted, there was a sig nif i cant in crease in staff knowl edge of EE and con fi dence in en gag - ing in di vid u als post train ing. The train ing also pro vided staff with knowl edge about the na ture of the neg a tive symp - toms of schizo phre nia, as these are found to be the most chal leng ing be hav iors that re sult from high EE. Neg a tive symp toms of ten cause in di vid u als to have a lack of mo ti va - tion, be so cially with drawn, and have a blunted af fect or a pov erty of speech. When staff is able to view an in di vid - ual’s prob lems, such as those re sult ing from neg a tive symp - toms, as out of their con trol, they are more likely to re act to a cli ent’s dif fi cult be hav ior in an un der stand ing and empathetic manner (Endley & Berry, 2011).

Con sid er ations for Staff Train ing

When con sid er ing pos si ble modes of train ing for in pa tient staff mem bers, it is im por tant to con sider cost of train ing, time con straints, method of eval u a tion, and re - sources needed. The most ben e fi cial in for ma tion to in clude is also an im por tant con sid er ation. Sev eral stud ies have found that men tal health staff mem bers with less than grad - u ate school train ing sig nif i cantly ben e fit from di dac tic trainings that in clude dis cus sions of ba sic in for ma tion re - gard ing SMI, be hav ioral re hearsal of so cial learn ing skills, and on go ing con sul ta tions to ad dress is sues that may arise dur ing the im ple men ta tion of these strat e gies (Cor ri gan, Holmes, Luchins, & Basit, 1995). Staff mem bers gen er ally are able to learn skills quickly and im ple ment them ac cu - rately as a re sult of trainings. De spite this find ing, few in pa - tient psy chi at ric fa cil i ties incorporate these types of trainings for staff members (Corrigan et al., 1995).

In ter ac tive Staff Train ing (IST) seeks to build co - he sion among in pa tient staff mem bers by hav ing them work to gether to make ac tive de ci sions about the pro gram (Cor ri - gan et al., 1995). IST in cludes sur vey ing staff re gard ing per cep tions about what would im prove the qual ity of cli ent care. In pa tient staff mem bers are more likely to par tic i pate and im ple ment pro grams that re flect their thoughts on cli ent needs. An other step in IST is reg u lar meet ings of a de vel -

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Journal of Applied Rehabilitation Counseling

op ment com mit tee made up of des ig nated staff and re ha bil i - ta tion pro fes sion als to ad dress pro gram pri or i ties and strat e gies. Dur ing these reg u lar meet ings, staff are taught prob lem solv ing strat e gies and in structed on how to gen er - ate, eval u ate, and choose op tions that in crease pro gram qual ity and staff par tic i pa tion. In ter ac tive Staff Train ing, if prop erly and reg u larly im ple mented in in pa tient pro grams, has the po ten tial to be a cost ef fec tive way to enhance staff resources to achieve better client outcomes (Corrigan et al., 1995).

Staff at ti tude and mo rale also greatly in flu ence the ef fec tive ness of a psy chi at ric re ha bil i ta tion pro gram and should be ad dressed reg u larly. Poor staff mo rale has neg a - tive ef fects on cli ent care and is eco nom i cally waste ful. Gilbody et al. (2006) found that staff mem bers work ing in psy chi at ric units ex pe ri ence some of the high est lev els of job dis sat is fac tion and burn out be cause of the na ture of cli - ents’ ill nesses. Strat e gies that have been eval u ated to im - prove the mo rale of in pa tient staff are ed u ca tional in ter ven tions that en hance staff com pe ten cies such as pos i - tive com mu ni ca tion skills, stress man age ment courses, and en vi ron men tal in ter ven tions that give at ten tion to ward de - sign and pro ce dures. These in ter ven tions have the po ten tial to en hance skills to ad dress cli ent prob lems and clin i cal dif - fi cul ties that are com mon in in pa tient psy chi at ric set tings. There is also po ten tial to in crease staff re ten tion and reduce sickness rates, which support the cost-effective nature of such interventions (Gilbody et al., 2006).

Along with staff mo rale, stigma and at ti tudes about cli ents with SMI can neg a tively im pact the ef fec tive ness of psy chi at ric re ha bil i ta tion in in pa tient set tings. SMI is of ten dif fi cult to un der stand. Many in pa tient staff mem bers may think of in di vid u als with SMI in a stig ma tiz ing way that can ex ac er bate prob lem be hav ior and hin der the pro cess of re - ha bil i ta tion. This stig ma tiz ing treat ment from staff mem - bers can lead the cli ent to de velop self-stigma by in ter nal iz ing these per cep tions. Stigma about men tal ill - ness can be ad dressed with ed u ca tion that con trasts myths with facts. These myths di min ish when con trasted with in - for ma tion based on long-term re search (Cor ri gan & Wassel, 2008). Pre sent ing staff mem bers with in for ma tion about the na ture of SMI and ev i dence sup port ing the interventions they implement helps improve client advocacy and staff attitudes.

As pre vi ously dis cussed, ef fec tive trainings for in - pa tient staff mem bers must pro vide com pre hen sive in for - ma tion about the na ture of SMI. This in cludes the im por tance of so cial skills train ing and pos i tive in ter ac tions with cli ents, as well as the ef fects of high EE on cli ent out - comes. Man da tory trainings for all in pa tient staff have the po ten tial to re duce stigma about SMI, make so cial skills train ing more ef fec tive, and lessen the like li hood of at trib - ut ing prob lem be hav ior to the cli ent, rather than the ill ness. Reg u lar meet ings be tween in pa tient staff should also be man da tory in or der to ad dress con cerns that staff may have about pro gram pro ce dures and to so licit sug ges tions for im - prove ment. To en cour age par tic i pa tion, staff should be reg - u larly sur veyed re gard ing what they be lieve could im prove

cli ent and pro gram out comes. Taken to gether, these com po nents of reg u lar staff train ing pro grams in in pa tient fa cil i ties can greatly im prove cli ent-staff in ter ac tions, re - sult ing in more positive rehabilitation outcomes for clients with SMI.

Con clu sion

Lit er a ture sup ports so cial sup port as a key com po - nent of the re ha bil i ta tion pro cess for in di vid u als with SMI. The ben e fits of train ing pro grams aimed at in creas ing psy - chi at ric staff mem bers’ knowl edge of SMI and the im por - tance of so cial skills trainings, pos i tive at ti tudes, and low EE to wards cli ents are em pir i cally sup ported. Fur ther in - ves ti ga tion and cre ation of ef fec tive train ing pro grams for staff that could be used in all in pa tient set tings con tin ues to be a need. Clear guide lines and as sess ment tools to em pir i - cally mea sure the ef fec tive ness of these pro grams in or der to generalize results to other inpatient settings are also needed.

Pro vid ing sim ple, reg u lar train ing to psy chi at ric staff mem bers that in cludes in for ma tion about proper so cial in ter ac tions, as well as in for ma tion about the na ture of SMI, will im prove the qual ity and out comes of psychosocial re - ha bil i ta tion pro grams. Also, staff ex pected to pro vide in ter - ven tions, such as psychoeducation and so cial skills train ing, must be prop erly pre pared to do so. Reg u lar meet - ings be tween pro fes sional staff and line-level staff are a cost-ef fec tive way to en hance com mu ni ca tion and mo rale among all in pa tient staff mem bers. In ad di tion, the de vel - op ment of a method of eval u a tion for as sess ing cli ent-staff in ter ac tions would al low the ef fec tive ness of these train ing in ter ven tions on pos i tive cli ent-staff interactions and rehabilitation outcomes to be carefully evaluated.

In pa tient staff mem bers are a pri mary source of so - cial in ter ac tion in cli ents’ lives. They must be aware of their in flu ence on the re cov ery pro cess of in di vid u als with SMI. Ev ery in ter ac tion is mean ing ful in these pro grams, even out side of struc tured ac tiv i ties. There fore, pos i tive and em - pa thetic at ti tudes of staff to wards cli ents can greatly im pact treat ment out comes. Train ing staff to in crease pos i tive in - ter ac tions to wards cli ents and im prove staff at ti tudes to - wards men tal ill ness will re sult in a sig nif i cant im prove ment to the over all at mo sphere in in pa tient care and pro mote the recovery of individuals receiving inpatient treatment.

Ref er ences

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Bellack, A. S. (2004). Skills train ing for peo ple with se vere men tal ill - ness. Psy chi at ric Re ha bil i ta tion Jour nal, 27(4), 375-391. doi:10.2975/27.2004.375.391

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Rog ers, E. S., An thony, W., & Lyass, A. (2004). The na ture and di men - sions of so cial sup port among in di vid u als with se vere men tal ill nesses. Com mu nity Men tal Health Jour nal, 40(5), 437-450. doi:10.1023/B:COMH.0000040657.48759.0e

Tay lor, T. L., Killaspy, H., Wright, C., Turton, P., White, S., Kallert, T. W., . . . King, M. B. (2009). A sys tem atic re view of the in ter na - tional pub lished lit er a ture re lat ing to qual ity of in sti tu tional care for peo ple with lon ger term men tal health prob lems. BMC Psy chi a try, 9 doi:10.1186/1471-244X-9-55

Danielle R. Critten, MA, is a grad u ate in Re ha bil i ta tion Coun sel ing in the Hu man Re ha bil i ta tive Ser vices Pro gram, the Uni ver sity of North ern Col o rado.

Jill L. Bezyak, PhD, CRC, is an As sis tant Pro fes sor in the Hu man Re ha bil i ta tive Ser vices Pro gram, the Uni ver sity of North ern Col o rado.

Juliet H. Fried, EdD, CRC, CVE, is a Pro fes sor in the Hu - man Re ha bil i ta tive Ser vices Pro gram, the Uni ver sity of Al - a bama.

Cor re spon dence con cern ing this ar ti cle should be ad - dressed to Jill L. Bezyak, Hu man Re ha bil i ta tive Ser vices Pro gram, Cam pus Box 132, Uni ver sity of North ern Col o - rado, Greeley, CO, 80639. Email: [email protected]

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Journal of Applied Rehabilitation Counseling

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