5/28/2014 Using Structured Behavioral Interventions to Enhance - PDF document

5/28/2014 Using Structured Behavioral Interventions to Enhance Mental Health Recovery in Psychosocial Rehabilitation Melanie Bennett, Ph.D., Julie McCarthy, MS, Thomas Tsuji, MA, Michele Crisafulli, MA Department of Psychiatry, University of Maryland School of Medicine Workshop Overview • Welcome • Background • Sample SBIs • Breakout groups to practice • Brief wrap-up What are SBIs? • Targeted and focused • Planned curriculum • Standard elements and content • Teach new skills • Can be tailored to individuals’ needs, interests, and abilities • Can target a range of skill domains or health behaviors 1

5/28/2014 Components of SBIs • One meeting (individual) for engagement, orientation, obtaining consent (if needed), and goal setting (what skills domains and specific skills to work on) • Meetings for teaching specific skills (can be done in individual or group format) • Groups are good for SBIs. Outline of a Standard SBI Meeting  1. Review homework  2. Give a rationale for the skill / lesson  3. Briefly share a relevant experience that relates to rationale  4. Explain the steps of the skill / components of the lesson  5. Model the skill / components  6. Role-play / complete experiential activity  7. Give feedback  8. Role-play / complete experiential activity again  9. Solicit feedback from the group  10. Repeat role play / activity / feedback  11. Repeat Steps 5-9 with each other group member (if in group format)  12. Give out homework Sample SBI Meeting Checklist 2

5/28/2014 Methods Used in SBIs • Teaching • Modeling • Role-playing • Reinforcement • Feedback • Taking a shaping approach • Overlearning • Generalization of learning Teaching • Content is provided as needed so that participants have context for the skills they are learning. • Content is also related to experiential activities that are part of some SBIs – Ex. Learning about habits, cravings, triggers, and high risk situations (for SBIs focused on substance abuse) Modeling • Group leaders set up a role-play to demonstrate how they would use the steps of the skill in a situation that group members might have experience with. • Group members are asked to observe the leaders and to discuss how they followed the steps. 3

5/28/2014 Role-plays • Set up role-plays to be realistic and lively – Individualize scene – Choose appropriate level of complexity (start easy and get more difficult) – Review steps prior to role play to make sure group member understands what is expected • Aim for 3 role plays for each group member in each session: “Third time is the charm!” Feedback • Emphasis on positive feedback; always start with positive • Feedback should be specific and related to steps of the skill • Routinely elicit feedback from group members • Corrective feedback – One or two suggestions for improvement at a time – Can be integrated into second and third role plays (“One thing that might make your role play even more effective. . . . “) Tone of SBIs • Positive, reinforcing • Collaborative, motivational approach • Consumer is most knowledgeable about him/her self • Learn skills and encouraged to think about how to apply them to one’s life 4

5/28/2014 SBIs: Points to Remember • SBIs are teaching, not psychotherapy • Keep sessions lively and interactive • Use flip charts, white boards, handouts • Prepare for sessions • Stay with the structure • Do not work in isolation • Do not passively expect participation • Be patient: learning skills takes time and repetition Challenges for Clinicians Learning SBIs • Allow too much time for discussion/processing • Hesitant to take role of “being in charge” • Quickly accept when consumer doesn’t want to role-play • Role-play scenarios are too complicated • Insufficient amount of positive reinforcement • Provide vague, non-behavioral feedback • Do not encourage consumer to be actively involved Practical/systems issues in starting groups Addressing Cognitive Deficits • Small group format • 1-2 leaders per group • Meetings are highly structured • Skills are reduced to smaller steps • Over-learning of a few basic skills • Use of visual aids, handouts, frequent review of material • Pacing, content can be adjusted as needed 5

5/28/2014 SBIs and Mental Health Recovery Elements of Recovery Model Goals and Strategies of SBIs √ Self-direction The client, not the counselor, should direct discussion around how skills are useful in his/her life. √ Strengths based Start where client wants to start. Build on strengths and competencies. Individualized/person-centered Collaborative, tailored to an individual’s √ interests and goals √ Empowerment The client is the primary resource in finding answers and solutions. √ Responsibility Client has autonomy. Responsibility for use of skills is with client. Respect Empathic, client-centered style. Avoid √ arguing. √ Hope Belief in the possibility of change. 16 SBIs We Have Done • Social Skills Training • Smoking Cessation • Weight Loss • Drug / Alcohol Abuse • Coping Skills • Stress Management • Vocational Skills • Relationship Skills Sample 1: Social Skills Training • SST helps consumers maintain or re-establish social relationships and prevent social withdrawal and isolation. • 4 domains: – Communication (“Social Networking”) – Friendship and dating (“Relating and Dating”) – Assertiveness (“Expressing Yourself”) – Conflict management (“Keeping Cool”). 6

5/28/2014 Behavioral Components of Social Skills • Speech Content • Paralinguistic Features – Voice volume – Pace – Pitch – Tone • Nonverbal Behavior – Proxemics, kinesics, gaze, facial expression • All are important to good social interaction. SST Goal Setting Meeting • Benefits – Helps with engagement, building rapport – Prepares consumer for what to expect – Links SST to consumer’s recovery goals – Identifying consumer’s goals important for selecting curriculum, setting up meaningful role plays, developing home assignments Common SST Goals • Making / re-making friends • Developing leisure activities to do with others • Getting a job • Keeping a job • Getting along with roommates • Reducing substance use • Being a better parent • Dating • Dealing more effectively with angry feelings 7

5/28/2014 Sample SST Session: Maintaining Conversations • Today we’re going to learn about Maintaining Conversations. This involves learning how to start talking with someone and keep talking to them for a few minutes. • Why do you think this is an important skill? • We’ve broken the skill down into steps: Step 1. Make eye contact and say Hello Step 2. Ask a general question Step 3. Make small talk by asking questions Step 4. Give a reason and say Good-bye General Questions • What’s up? • How are you doing? • How have you been? • What do you think of this weather? • What’s new? • Are you new here? Topics for Small Talk • Weather • Hobbies • Sports • Culture – TV – Music – Entertainment • Remember: Small talk involves topics that everyone can talk about. 8

5/28/2014 Ways to Say Goodbye • Well, I have an appointment. I have to go. • I have to catch a bus. See you later. • I have to meet a friend. It was good to see you. • Group is about to start. I’ll talk to you later. Sample 2: Behavioral Treatment for Smoking Cessation • BTSC helps consumers prepare to quit and take steps towards quitting • 4 domains: – Motivational Enhancement & Reinforcement [Motivational interviewing, breath CO monitoring, goal setting] – Engagement [Education, smoking cessation care coordination] – Skills Training [Stop smoking skills, social and coping skills training, relapse prevention] – Psychopharmacology [Education re: Zyban/NRT, coordination with prescribers, tracking NRT use, problem-solving] Goal Setting in BTSC • Participants create a concrete goal to work on between sessions. • Goals written down in a formal "contract". • Allows for a review of individual progress towards smoking reduction/quitting. • Can vary for those planning a quit date and those who are working on staying quit. 9

5/28/2014 Sample Goal Setting Form: Setting a Quit Date Skills Training in BTSC • Stop smoking skills focus on strategies for quitting smoking. • Coping skills focus on strategies for coping with negative states (depression, stress, medication symptoms and side effects) without smoking. • General social skills focus on helping patients reduce interpersonal conflict/stress. Sample Quit Smoking Skills Coping with Withdrawal Symptoms Ways to Cope with the After Quitting Habit of Smoking (adapted from the American Lung Association Freedom from Smoking) Hold a pencil Symptom Relief Squeeze a tennis ball in your hand. Irritable, anxious Walk, bath, relaxation Carry some carrot or celery sticks around Depressed Do something fun, talk with you and eat them if you have this feeling Restless Walk, relaxation, fun Trouble sleeping No caffeine, relaxation Chew something - a toothpick, a lollipop (remember Kojak), hard candy, sugar Poor concentration Plan light load, avoid free gum. stress Drink a glass of water Hungry, weight Drink water and low-cal drinks, eat low-cal Change your routine snacks (carrot sticks, pretzel sticks, sugar free Brush your teeth after a meal; Go for a candy/gum) walk; Spend time in nonsmoking locations (library) or with nonsmoking Stomach problems Drink fluids, lots of fiber people 10