Independent living skills

Once clients are able to manage their symptoms and interact effectively with other people, they’re ready to learn or re-learn the day-to-day skills they need to function independently and make a full recovery. Examples of IADLs in this section include skills such as paying bills, interviewing for jobs, signing lease agreements, using public transportation, doing laundry, transitioning from a R&B to a private apartment, shopping for food, preparing meals, etc.

 

G: Dawnice is a 39-year-old African American female. Due to lack of motivation and energy, low tolerance for frustration, and life-skill deficits secondary to her mental illness, Dawnice relies on others to drive her places she needs or wants to go. She believes it is her PSC’s responsibility to provide transportation whenever she requests it, to run personal errands and engage in activities unrelated to her recovery, and becomes aggressive and confrontational if her demands are not met. I met with Dawnice today to clarify the purpose of the program and my roles and responsibilities as her PSC.

I: I explained to Dawnice that the goal of the program is to help her develop skills and access resources so she can live the kind of life she wants to without having to rely on the system. I reminded Dawnice how stressful it is for her to have to rely on others to get by from month to month, never knowing for sure whether they will come though for her. I explained that my role as her PSC was to help her make positive changes in her life so that she no longer had to depend on others to get her needs met, and that if I allowed myself to function as a her personal attendant and driver I would be making her more dependent on the system rather than less dependent on it, which was not in her best interest and not supportive of her recovery. I informed Dawnice that there were many alternatives she could utilize to get around on her own, such as public transportation, ACCESS, Uber, and Lyft, and that I would be happy to help her learn to access these resources. I explained that these services would be available to her any time she needed to use them, and that by becoming proficient with them she could reduce or eliminate much of the stress she currently experiences over issues involving transportation.

G: Brenda is a 44 y/o single Caucasian female. Due to the severity of her mental illness, Brenda has been cared for by other adults for most of her life. Tasks she normally would have learned to do herself were instead done for her by family members, R&B staff, case managers, etc. As a result, when Brenda needs to schedule an appointment with an outside provider such as her PCP, she calls her mental health worker rather than calling the provider directly. This leads to delays, misunderstandings, and unnecessary back-and-forth calls. I met with Brenda today to teach her the skill of scheduling appointments on her own.

I: Brenda needed to make an appointment with her PCP so I used the call as an example. Explained to Brenda that before she picks up the phone, she should prepare by deciding who she needs to call and being sure she has the right number. Next she should think about any cards or IDs she might need and have them out in front of her. I suggested she remind herself of what she wants and rehearse asking for it, being as concise as possible. I modeled this for her, showing her how to greet the person on the other end, identify herself, and explain what she wanted. Modeled how to briefly summarize why, without going into a long, drawn-out story with unnecessary details. Explained that before making the call, she should consider appointment times that would work for her, factoring in bus schedules, availability of transportation, her morning routine, etc. Suggested she have a pen and paper handy to jot down notes before, during, and after the call. I modeled writing an appointment time down, reading it back to the person on the other end to confirm I had the right information, and double-checking to be sure I had the right address for the provider. I then made the actual call to Brenda's PCP and again modeled the skills we had just covered.

G: Leon is a 51 y/o single African American male. Leon was diagnosed with schizophrenia in his early 20's and has lived in group homes or been homeless for most of his adult life. As a result, he never learned how to prepare a meal for himself. His diet consists almost exclusively of junk food (e.g., chips, candy, french fries) which his doctor has advised him to avoid due to his being overweight and pre-diabetic. I met with Leon at his R&B to work on his current objective of increasing the number of nutritionally-balanced meals he eats, from a baseline of 0 per day to a goal of at least one per day.

I: I began by explaining the potential benefits of today's activity: Normalizing body weight, improving health, increasing self‐confidence and experience with food preparation skills, and increasing self‐sufficiency and self‐esteem. I then reviewed with Leon the three basic parts of a recipe: The list of ingredients and how much of each is needed, step-by-step instructions, and additional information such as what size baking dish to use, how long to cook, and at what temperature to cook. I had Leon read through some recipes and identify each of these parts in it, then choose a recipe he felt he might want to try in the future. I asked if he was familiar with the ingredients and cooking tools listed and answered questions he had. Gave him a list of cooking terms and abbreviations, reviewed it with him, and explained words and terms he did not understand.

G: Teresa is a 29 y/o single Filipino female diagnosed with schizoaffective disorder. As a result of her symptoms (A/H, paranoia, mood swings, and angry outbursts) she became homeless at an early age and failed to acquire age-appropriate skills in multiple areas, including her ability to perform ADLs and IADLs (see CFS 4 in current CP). I continued working with Teresa today on her objective of learning to do her own laundry.

I: Reviewed material covered in our last lesson about washing clothes. Then I explained that today's lesson on drying would help Teresa preserve the quality of her clothes and avoid melting elastic and other heat-sensitive parts of her laundry, and prevent her clothing from smelling like mildew. These have been problems for her in the recent past. Teresa had washed a load of clothes as directed before I came. I then took her through the 5 steps involved in drying: Shaking and detangling items, sorting the pieces by the kind of drying they needed, putting them in the dryer along with a static sheet, setting the time and heat on the dryer to the lowest amounts necessary to completely dry her clothes, and turning the dryer on. I modeled these for Teresa then had her try doing them while I provided coaching and feedback.

G: Gene is a 47 y/o single Caucasian male who is diagnosed with schizophrenia. Due to disorganized thinking and diminished self-awareness, he will go for weeks without showering, brushing his teeth, combing his hair, shaving, and changing into clean clothes. As a result he becomes malodorous and unkempt looking, which contributes to impairments in social functioning.

I: Met with Gene at his B&C. Explained the purpose of today's exercise, which is to help increase his self-esteem and confidence, make social integration and social interactions easier for him, and to improve his living skills by integrating a grooming and hygiene routine into daily life. Introduced the "Feeling Good Through Grooming" handout and reviewed the directions on facial care, brushing teeth, showering, using deodorant, shaving, shampooing hair, clipping nails, and washing/changing clothes. I gave examples and modeled or demonstrated when possible. Clarified words and ideas Gene had trouble understanding. Provided Gene with a second handout, "Daily Self-Care Tasks Log" to help him track tasks he was already performing, list ones he would like to add, the supplies he would need, and potential barriers such as running out of time in the morning.

G: Dorthia is a 47 y/o African American female. Dorthia is preparing to graduate from TAO and move to a lower level of care. Her symptoms are now well-controlled, but because she was highly symptomatic for many years, she has skill deficits in multiple areas, including a lack of experience living on her own in an unsupported setting (see CFS 1 and 4 of current CP).

I: I explained to Dorthia that the purpose of today's session was to begin thinking about the various tasks she will need to complete throughout the transition process and once she is living on her own, and identify areas where she might need additional training or support. I introduced her to the "Gearing Up for the Move" checklist which covers concerns such as how her budget might be affected and how her transportation needs might change. We brainstormed to come up with additional concerns and added them to the checklist, such as scheduling of psychiatrist appointments (i.e., will change from a passive to an active task, and will require planning in advance), and what she will do if her symptoms seem to be getting worse. I encouraged Dorthia to add to the list as ideas came to her, and explained that next week we would develop a plan for addressing items she was unsure about.

G: Manuel is a 29 y/o single Hispanic male. I met with Manuel today to work with him on his current objective of increasing the number of times he comes to TAO to meet with his doctor, as opposed to her having to drive to his R&B to meet with him.

I: Engaged Manuel in a discussion about the costs and benefits of allowing himself to remain dependent on others. We talked about the effects this behavior has on his self-esteem, and the missed opportunities to meet people and make new friends. Discussed the effect that getting out and doing things can have on a person’s mood, as opposed to remaining isolated and alone.  Since Manuel’s paranoia and anxiety are major contributors to his reluctance to come to TAO, I modeled anxiety reduction techniques he could use such as deep breathing, focusing on the sensations of breathing (as a way of diverting his attention away from anxiety-provoking thoughts), and progressive muscle relaxation.

G: Manuel is a 29 y/o single Hispanic male. Manuel depends on others for transportation to appointments which frequently prevents him from attending them, which in turn reduces his ability to get consistent mental health care and medications to manage his symptoms. I met with Manuel today to continue working with him on his current objective of increasing the number of times he comes to TAO and meets with his doctor here, instead of her having to drive out and see him at his R&B.

I: Engaged Manuel in a discussion about situations that caused him to feel anxious, then helped him identify what it was about those situations that made him anxious. Some of his concerns were valid but many were not, such as the idea that law enforcement would be watching and following him, that his behavior might be videotaped and used against him in court, and that he might be "walking into a trap". Manuel is generally reluctant to discuss personal issues so I praised him for his willingness to talk with me about his concerns. I explained that next week, we would look at evidence supporting these concerns and weigh it against evidence suggesting they are not true.

 

All PHI has been de-identified per HIPAA Privacy Rule