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VA Psychosocial Rehabilitation Training Program (U.S. Department of Veterans Affairs)

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VA Psychosocial Rehabilitation
Training Program
Social Skills Training for
Serious Mental Illness
Director: Alan S. Bellack, PhD, ABPP
Co-Director: Richard W. Goldberg, PhD
Goals Monitoring
Sheet: Social
Skills Goals Clinician
Rating
Scale
(Example)
12
VA Social Skills Training for Serious Mental Illness
VA Social Skills Training for Serious Mental Illness
HANDBOOK TABLE OF CONTENTS
Section I: Program and Workshop Information
Brief Program Description 2
Program Staff (Baltimore) 3
Program Staff (Los Angeles) 4
SST Workshop Agenda 5
Section
II: Practical
Resources
Social Skills Training Resources
Guideline
for Individual
Sessions
7
Brief
Goal
Assessment: Social
Skills Training
Individual
Goal
Assessment (E
xample)
8
Sample
Group
Expectations Handout
9
Example
Group
Information
Handout t
o V
eterans
10
Group
Session
Sequence
11
Strategies for Common
Challenges
13
Tips
for Dealing
with
Other Common
Challenges in
SST Groups
15
Consultation
Resources
Consultation
Plan: Tape
Viewing
Plan
and
Competence Ratings
62
Tips for Identifying
and
Using
Individual
SST Goals
63
Social
Skills Group
Observation
Checklist
65
Web
Based Consultation
Tracking
System –
Information
and
User Instructions
67
Tips for Entering
Helpful Information
into
the
Web
Based System
70
Audio Recording Resources
Audio Taping
Consent Tips
74
Privacy
Officer Documentation
–
Audio Ta
pe
Procedures for SST
Facilitators and
Consultants
75
Audio Recorder –
User Instructions
77
Preparing for Facilitating Groups
Developing
a Curriculum
79
Sample
Curriculum Domains
81
Social
Skills Training
Task
Checklist
–
Immediately
After Workshop
82
Social
Skills Training
Task
Checklist
–
Individual
Sessions
83
Social
Skills Training
Task
Checklist
–
SST Group
Sessions
84
Material and
Practical
Needs
85
Important Pages in
the
SST Book
86
Recruitment Planning
87
Recruitment Resources
Example
Recruitment Flier for Patients –
Open
Group
89
Example
Recruitment Flier for Patients –
Closed
Group
90
Example
Treatment Team
Handouts
91
Clinical Notes Resources
Example Clinical
Note
Template
–
Individual
sessions
94
Example Clinical
Note
Template
–
Group
sessions
95
Additional Resources
Reference List
for Social
Skills Training
97
1
VA Social Skills Training for Serious Mental Illness
Program and Workshop
Information
2
VA Social Skills Training for Serious Mental Illness
BRIEF PROGRAM DESCRIPTION
VA Psychosocial Rehabilitation Training Program
(a.k.a. VA Social Skills Training for Serious Mental Illness)
Director: Alan S. Bellack, PhD, ABPP
Co-Director: Richard W. Goldberg, PhD
The VA Psychosocial Rehabilitation Training Program (VA-PRT) is funded by
the Office of Mental Health Services at VA Central Office as part of an overall
emphasis on increasing availability of evidence-based psychotherapy and
other psychosocial treatments for Veterans. The program, based at the VA
Maryland Health Care System, provides training, technical support and
consultation in evidence based psychosocial interventions to VA practitioners
and mental health program leaders working with seriously mentally ill
veterans and their families. The program will train VA staff members in
Social Skills Training, through a combination of 2-day face-to-face
workshops and 24-weeks of follow-up clinical supervision and consultation.
VHA staff from around the country will be trained in Maryland and California.
The VA-PRT program has an evaluation plan to assess the effects of the
training.
Additionally, availability of Social Skills Training is required for individuals
with serious mental illness as per the Uniform Mental Health Services in VA
Medical Centers and Clinics (2008). Specifically, the handbook requires that:
3
•
Recovery and rehabilitation-oriented programs must be available for all
SMI patients.
•
A minimum array of services available to veterans in the program through
PRRC staff needs to include Social Skills training.
•
Social skills training is an evidence-based psychosocial intervention that
must be available to all veterans with SMI, whether it is provided on site,
by referral, or by telemental health.
•
Social skills training must be provided at all medical centers.
VA Social Skills Training for Serious Mental Illness
PROGRAM PERSONNEL DIRECTORY– BALTIMORE STAFF
PROGRAM PERSONNEL– BALTIMORE
Alan S. Bellack, PhD, ABPP
Director, VA Psychosocial Rehabilitation Training Program
Alan.Bellack@va.gov
Richard W. Goldberg, PhD
Co-Director, VA Psychosocial Rehabilitation Training Program
rgoldber@psych.umaryland.edu
Joanna Strong Kinnaman, PhD
Program Manager/Consultant
jokinnaman@earthlink.net
Matthew Wiley, MPH
Program Coordinator
Matthew.Wiley@va.gov
Jean S. Gearon, PhD
Trainer/Consultant
Jean@Gearons.com
Cynthia Clark, RN
Trainer/Consultant
Cynthia.Clark2@va.gov
Wendy N. Tenhula, PhD
Workshop Trainer
Wendy.Tenhula@va.gov
Amy Drapalski, PhD
Trainer/Consultant
Amy.Drapalski@va.gov
Rebecca Pasillas, PhD
Trainer/Consultant
Rebecca.Pasillas@va.gov
Sophia Autrey, MPH
Program Evaluator
Sophia.Autrey@va.gov
Bradley E. Karlin, PhD
Director, Psychotherapy Programs
Office of Mental Health Services, VA Central Office
Bradley.Karlin2@va.gov
4
VA Social Skills Training for Serious Mental Illness
PROGRAM PERSONNEL DIRECTORY– LOS ANGELES STAFF
Stephen R. Marder, M.D.
Director, VISN 22 MIRECC
marder@ucla.edu
Shirley M. Glynn, Ph.D.
Trainer/Consultant
sglynn@ucla.edu
Frederick H. Martin, Psy.D.
Trainer/Consultant
Frederick.martin2@va.gov
Susan Gingerich, MSW
Workshop Trainer
gingsusan@yahoo.com
Elizabeth A. Gilbert, Ph.D.
Trainer/Consultant
elizabeth.gilbert@va.gov
Lisa J. Hayden, Psy.D.
Trainer/Consultant
DrLisaHayden@roadrunner.com
5
VA Social Skills Training for Serious Mental Illness
2-DAY WORKSHOP AGENDA
Day 1:
8:00a.m. Registration opens
8:30a.m. Convene and Introductions
8:45a.m. Plenary Presentation on Recovery and Introduction to VA
initiative for dissemination of Evidence Based Practices
9:45a.m. Presentation of the Soci
al Skills Training Model: What is the
model and how do you teach it?
10:30a.m
. Break
10:45a.m. Video viewing of a SST group and discussion
11:30a.m. Overview of VA-SST Project and Discu
ssion of Consultation
Model
12:00p.m
. LUNCH
1:00p.m. Breakout groups until 3:30p.m. (10-minute breaks at 1:50 and 2:50)
3:45p.m. Orienting Veterans to the SST Groups
4:15p.m. Brief role-play (in dy
ads) of dialogue with veteran to obtain consent
and discussion
4:25p.m. Par
ticipants will be asked to list three challeng
es they expect in
implementing soc ial skills training g roups at their agency.
Participants will be asked to do this before they leave the room.
4:30p.m. End
of Training Day 1
6
VA Social Skills Training for Serious Mental Illness
2-DAY WORKSHOP AGENDA (CONTINUED)
Day 2:
8:00a.m. Orientation to Day 2
8:15a.m. Panel discussion on strategies for common clinical challeng
es in
conducting SST groups
9:00a.m
. Breakout groups until 12:00p.m. (10-minute breaks at 10 and 11)
12:00p.m. LUNCH
1:00p.m. Starting a Social Skills Training Group in the VA
2:00p.m. BREAK
2:15p.m. Technical Aspects of the VA-SST Project
3:00p.m. Wrap-up and Evaluations
3:30p.m. End of Training Day 2
7
VA Social Skills Training for Serious Mental Illness
Social Skills Training
Resources
8
VA Social Skills Training for Serious Mental Illness
GUIDELINE FOR INDIVIDUAL SESSIONS
1. Introduction of facilitator(s)
2. Discuss purpose of group; how different from “other” groups
3. Discuss general format of groups (i.e., homework review, skill
introduction, role plays, feedback, homework)
4. Discuss group expectations [NOTE: IF CLOSED GROUP MAY DO
THIS AT FIRST GROUP SESSION]
5. Obtain
informed consent
for
audio
t
aping [NOTE:
OBTAIN
CONSENT
PRIOR
TO AUDIO TAPING INDIVIDUAL
TAPING]
6. Goal sett
ing
7. Give handout with facilitator names and contact info, group setting
info (time, room, etc.)
9
VA Social Skills Training for Serious Mental Illness
BRIEF GOAL ASSESSMENT:
SOCIAL SKILLS TRAINING INDIVIDUAL GOAL ASSESSMENT - EXAMPLE
Name:
Jane Veteran
Date: 9/15/08
Education (highest level completed):
th
11
Current occupation: Work in linen room
Work history: Used to clerical work (~1982-1995); U.S. Army (1979-1982)
What activities are you involved in on a daily or weekly basis? Watch t.v., go to
VA to linen room and appointments, Go to coffee shop and play cards
Are there any activities that you are currently not participating in but would like to?
Used to like to bowl, but can’t anymore with back problems; like to do
puzzles; Used to like photography
Who are the people you spend most of your time with? People in group home –
especially Bob; People in linen room; My sister visits on some Saturdays (~2X
per month)
Are there people whom you do not currently spend time with but would like to? I
wouldn’t mind having a boyfriend; Can’t think of anyone else
Identify two goals that you would like to achieve within the next 6 months (short-term
goals).
1. Work 20 hours instead of 15
2. Maybe get camera fixed
Identify two goals that you would like to achieve within the next year (long-term goals).
1. Get a boyfriend
2.
From Social Skills Training for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
10
VA Social Skills Training for Serious Mental Illness
SAMPLE GROUP EXPECTATIONS HANDOUT
Social Skills Training
GROUP EXPECTATIONS
1. Please stay on the group topic.
2. Only one person may speak at a time.
3. No name-calling or cursing.
4. No criticizing or making fun of each other.
5. No eating or drinking during group.
6. Others?
11
2
nd
(floor)
213B
(
room)
VA Social Skills Training for Serious Mental Illness
EXAM
PLE GROUP INFORMATION HANDOUT TO VETERANS
WELCOME TO SOCIAL
SKILLS TRAINING
GROUP!!
In Social Skills Training groups, we will talk about
and practice new ways of getting along with other
people. In this group we will not spend a lot of time
talking about problems and feelings. The main way
group participants practice new skills is through
role-plays (pretending to be in a particular situation
and acting it out) and getting feedback from the
group. The feedback is positive and the groups end
up being fun.
We look forward to you joining the group!
Here is some important information for you about the
groups:
Name of the Group
Lead
er(s):
Dr. Gearon
Contact phone number: 222-5555
When
the groups are held: 3pm-4:30pm
(time)
Tuesdays & Thursdays
(days of the week)
Where
the groups are held: 38
(building)
12
VA Social Skills Training for Serious Mental Illness
GROUP SESSION SEQUENCE
1. Review homework
2. Give a rationale for the skill
3. Briefly have members share a relevant experience or rationale
4. Explain the steps of the skill
5. Model the skill; review the model
6. Have a group member role-play
7. Give feedback
8. Have the member role play again
9. Solicit feedback from the group
10. Repeat role-play again and provide feedback
11. Repeat Steps 6-10 with each other group member
12. Give out homework
13
VA Social Skills Training for Serious Mental Illness
GOALS MONITORING SHEET:
SOCIAL SKILLS GOALS CLINICIAN RATING SCALE - EXAMPLE
Name: Jane Veteran Date: 12/27/08
Clinician: Dr. White
Check Rating Period: Initial: ; 3 months X ; 6 months ; Other time period
Clinician: Please list all goals set at initial meeting as initial goals. All goals that are
modified should be listed in the lower section under “Modified/New Goals.” Any goals
set in subsequent meetings are also recorded in the “Modified/New Goals” section.
Dates of goal outcomes should be placed in the selected boxes.
Initial Goals
Goals
Date set
Not
achieved
Partially
achieved
Fully
achieved
Modified
(see below)
1. Increase work hours
to 20 per week
9/15/08
12/27/08
12/27/08
2. Start a
conversation with a
male
9/15/08
12/27/08
3.
4.
Modified/New Goals
Goals
Modified
from
goal #
Date set
Not
achieved
Partially
achieved
Fully
achieved
Modified
5. Increase work
hours to 18 a
week
1
12/27/08
6.
7.
8.
From Social Skills Training for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
14
120
VA Social Skills Training for Serious Mental Illness
PRINCIPLES, FORMAT, AND TECHNIQUES
TABLE 8.2. Strategies for Common Problems in Social Skills Training Groups
General Principles
1. Encourage participation by each person according to his or her ability.
2. Set clear expectations.
3. Praise small steps toward improvement.
Specific problems Strategies
Difficulty in follo
wing
group format
At the begi
nning of group, remind members of format.
As group progresses, point out each phase.
Consistently redirect people when they go off the topic or interrupt others.
Provide written handout or poster of format if problems persist.
Reluctance to role play Acknowledge shy feelings.
Engage person in observing others role play.
Engage person in providing feedback.
Start with a shortened version of role play.
Gradually increase the number of steps to perform in a role play.
Providing vague or
critica
l feedback
Consistentl
y model appropriate feedback.
Guide people by asking questions about specific steps.
Stop critical comments.
Reframe criticisms into constructive suggestions.
Provide handout or poster about feedback if problems persist.
Difficulty in compl
eting
homework
Write down
assignments.
Start with simple tasks.
Help plan where, when, and with whom assignments will be completed.
Review previous assignment at beginning of each session.
Problem solve about obstacles encountered in completing assignments.
Consistently assign and follow up homework.
Request assistance in completion from family or staff members.
Tailor assignment to the individual.
From Social Skills Training
for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004
by The Guilford Press. Permission to photocopy this form is granted to
purchasers
of this
book for personal use only (see copyright page for details).
15
Di
sruptions related
to symptoms
128
VA Social Skills Training for Serious Mental Illness
PRINCIPLES, FORMAT, AND TECHNIQUES
TABLE 8.3. Strategies for Problems Related to Clients Who Experience Severe Symptoms
General Principles
1. Keep communication brief and to the point.
2. Be consistent in maintaining structure and holding group at same time and in same place.
3. Praise efforts and small steps toward improvement.
4. Teach and review basic skills frequently.
Specific problems Strategies
Po
or attendance Build rapport by communicating warmth and enthusiasm.
Set small goals.
Use reinforcers such as praise, m
oney, food, increased privileges, time
with a favorite person.
Enlist h
elp of other staff members or family members.
Identify obstacles to attendance.
Consistently request person to attend.
Cognitive difficulties Keep group time relatively short.
Check frequently whether people are understanding.
Simplify language and instructions.
Allow members ample opportunity to observe and practice skills.
Responding to
psychotic
symptoms
For delayed response, allow extra time for people to respond or suggest
that they take their turns later.
Conduct sho
rter groups (30-40 minutes).
Emphasize role plays rather than discussion.
Give brief, clear instructions.
Check frequently for comprehension.
Assign active roles (such as role pl
ays) to clients who are distracted by
symptoms.
Distractib
ility Keep other distractions to a minimum.
Avoid lengthy explanations.
Use examples, role plays to illustrate points.
Redirect promptly to topic of group.
Design engaging role plays that are relevant to real-life situations.
Use a pleasant, sufficiently loud voice.
Assign specific tasks to group members observing role plays.
Reassure people of safety of group.
Redirect kindly and firmly to topic of group.
When appropriate, link content of disruption to skill being taught.
Suggest discussing person’s off-topic concerns after group.
Teach social skills designed to manage symptoms.
Withdrawal Understand that withdrawal is not a criticism of leaders or group.
Build rapport by communicating in a warm, low-key manner.
Avoid excessive questioning.
Avoid interpretations of why the person is withdrawn.
From Social Skills Training for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
16
VA Social Skills Training for Serious Mental Illness
TIPS FOR DEALING WITH OTHER COMMON CHALLENGES IN SST GROUPS
Challenge: Veteran refuses role-plays
Potential Sol
ution(s):
1. Encoura
ge the veteran to observe others role-play and provide feedback
before role-playing
2. Encourage veteran to try one or two steps of the role play first
3. Allow the veteran to role-play from their seat versus coming to the center of
the room
Challenge: Veteran is very quiet or keeps falling asleep
Potential Sol
ution(s):
1. Encoura
ge the veteran to come up and role-play next
2. “Assign” the veteran to provide feedback on a specific step of a role-play
3. Call on the veteran by name for feedback or input
4. Keep group sessions lively and animated
Challenge: Veteran dominates the group (e.g., try to answer all the questions,
jump in first with feedback after role plays)
Potential Solution(s):
1. “Assign” multiple veterans to provide feedback on a specific step of a role-
play
2. Call on other veterans by name for feedback or input
3. Encourage the veteran to do the next role-play
4. Kindly remind the veteran to provide his/her peers opportunities to respond,
provide feedback, participate, etc.
Challenge: Veteran talks about outside topics
Potential
Solution(s):
1. Kindly acknowledge what the person said and redirect back to the group
2. Use the agenda or group expectations of the group to get the person back on
track (e.g., “OK. I heard what you said about difficulties with your payee. But
let’s focus right now on Joe who is getting ready to do a role-play.”)
3. Kindly acknowledge what the person said and encourage the veteran to come
speak with you after group
4. Kindly acknowledge what the person said and encourage the veteran to
discuss the issue in another forum (e.g., individual session with case
manager, another group)
5. When relevant, encourage the veteran to practice a role-play scenario related
to the topic they are discussing
6. Post “Group Expectations” in group room or provide as handouts at the
beginning of group
17
VA Social Skills Training for Serious Mental Illness
TIPS FOR DEALING WITH OTHER COMMON CHALLENGES IN SST GROUPS
(CONTINUED)
Challenge: Vetera
n is a high functioning client who says how easy this is for
him/her
Potential Solution(s):
1. Encourage the veteran to use his/her skills and provide helpful feedback to
other group members
2. Ask the veteran to help you model the skill
3. Make role-play scenarios for the veteran a bit more challenging
4. Focus on the veteran’s goals when discussing the rationale for using the skill
and when creating role-play scenarios
Challenge: Veteran makes critical feedback about others' role-plays
Potential Sol
ution(s):
1. Kindl
y remind the veteran to start with positive feedback after role-plays
2. When providing corrective feedback, rephrase critical comments to
constructive feedback
3. Develop group expectations that group members provide positive feedback
first and then corrective/constructive feedback on role-plays
4. Post “Group Expectations” in group room or provide as handouts at the
beginning of group
Challenge: Veteran displays manic symptoms (may need to pace, speak rapidly,
etc.)
Potential Solution(s):
1. Encourage the veteran to come up and role-play next
2. “Assign” the veteran to provide feedback on a specific step of a role-play
3. Call on the veteran by name for feedback or input
4. Encourage the veteran to take a break from the group
18
VA Social Skills Training for Serious Mental Illness
Consultation Resources
19
VA Social Skills Training for Serious Mental Illness
CONSULTATION PLAN: TAPE REVIEWING PLAN AND COMPETENCE RATINGS
Individual (goal setting) Sessions:
o Consultants will listen to at least one full individual session of each
clinician.*
o Clinicians will be asked to report the goals of each veteran after every
individual session through the web-tracking system.
o If a clinician asks for additional assistance through the web-tracking
system on an individual session, the consultant will listen to that tape,
or part of tape, (if available) and provide feedback regardless if it is a
“required” tape to listen to.
Group Sessions:
o Consultants will initially listen to (all) full group session tapes of
clinicians.
o After a clinician reaches competence, consultants will listen to every
fourth tape. They will listen to full sessions of these tapes.
o If a clinician asks for additional
assistance through the web-tracking
system on a particular part of a session,
the consultant will listen to
this part and provide feedback regardless if it
is a “required” tape to
listen
to.
o If a clinician starts to demonstrate difficulties in facilitating the group
after they reach competence, a consultant may request that the
clinician audiotape additional groups.
*Note: The clinician will be asked to start audio-taping the individual session
after they obtain consent. Therefore, the entire session will not be taped.
Clinician Competence Plan:
Consultants will rate clinician competence in order to inform and guide
decisions about consultation. Clinicians continue in consultation for the full
consultation period (~24 weeks) regardless of competence status.
The primary measure used to rate competence is the SOCIAL SKILLS GROUP
OBSERVATION CHECKLIST (Bellack,
Mueser, Gingerich, & Agresta, 2004).
This measure includes two sections. The first section
includes 8 items related
to general group structuring and positive engagement skills; the second
section includes 9 items measuring facilitation of each of the steps in social
skills training.
Each
item is rated as “Fully”, “Partially”, or “Not at all”
performed.
20
VA Social Skills Training for Serious Mental Illness
TIPS FOR IDENTIFYING AND USING INDIVIDUAL SST GOALS
After each clinician demonstrates competence in leading SST g roups, clinicians will
be encouraged to work on developing and utilizing veterans’ social skills goals. This
includes clinicians become skilled at helping veterans set appropriate social skills
goals and using th ose goals within the social skills groups to help veterans move
towards the things in their lives that are important to them and their recovery.
As defined below, consultation around SST goals will be focused on helping
clinicians (1) identify appropriate SST goals; (2) identify role-play scenarios and
practice assignments related to veterans’ goal(s); and (3) monitor the goal of at
least one veteran during SST group participation.
I. Identifying goals
Consultants will assist clinicians in helping at least one veteran identify an
appropriate SST goal. There are three major components related to helping
veterans identify appropriate goals:
(1) Relate goal to social skills. Although veterans may come up with a wide
variety of goals or areas that they want to work on, it is important that their goal(s)
focus on socially related interactions or interpersonal relationships.
(2) Identify an objective goal. Many veterans may describe unspecific goals such
as “I want to feel better” or “I want to have higher self-esteem.” The clinician
should help the veteran establish a goal that is observable. Most likely the clinician
will use a questioning method to help the veteran shape the goal from something
subjective and vague to something that could be observed by an outsider. An
example of a question that might help develop a more objective goal is, “If you had
higher self-esteem what would you be doing more often; or be doing less often?
How would socially related aspects of your life be different?” Examples of more
objective goals might include: I want more friends, I want to have more
conversations, I want to see my family more often. The clinician should help the
veteran establish a realistic and attainable goal.
(3) Make goal measurable. After the veteran is able to establish their goal in
objective terms, it is recommended that the clinician help the veteran make the
goal measurable. A very helpful way to start this process is to ask the veteran how
many conversations, for example, they currently have in a week in order to
establish a baseline. The clinician can then be encouraged to follow-up with what
the vet wants for their goal. To continue with the same example as above, this
might include a question such as, “How many conversations would you want to try
to have with other individuals per week?” The clinician should be encouraged to
help the veteran come up with a number that is realistic and attainable.
In addition to goals being related to SST, objective, measurable, and attainable,
goals should also be focused more on near-term rather than long-term goals. A
veteran may establish a longer-term goal (e.g., find a girlfriend) and the clinician
should be encouraged to help the veteran clarify short-term goals that are
21
VA Social Skills Training for Serious Mental Illness
intermediate steps toward that longer-term goal (e.g., have a conversation with a
woman).
II. Utilizing SST goals
A critical comp
onent of using social skills goals is to help veterans establish
opportunities to practice scenarios related to their goals. The two primary means of
encouraging this type of practice is through role-play scenarios and homework
assignments. Consultants will encourage clinicians to help veterans develop role-
play scenarios and homework assignments that are related to veterans’ goal(s) in
at least one SST g roup.
Role-play
scenarios.
After
clinicians have mastered the basic concept
of the SST
groups,
clinicians will
be encouraged to use
veterans’ SST
goals in
the groups (if
this has not
yet occurred).
When
clinicians are helping v
eterans develop scenarios,
they
should
ask
veterans about
their
goals or remind th
em
what their
goals are.
They
should
work
collaboratively
with
the veteran to develop scenarios they
can
practice related
to their
goals.
Homework
assignments.
Homework
is an excellent
forum
to facilitate opportunities
for veterans to work
towards their
goals.
Clinicians should
work
with
veterans in
a
collaborative fashion to establish plans
for homework
that are related
to veterans’
goals.
The ultimate goal
for homework
development
that is the veteran knows who
they
will
practice with
and
what they
will practice prior to leaving th
e group; it
is
often helpful
for veterans to know
where and
when they
will
practice (i.e.,
when
they
will
see
or speak
with
the individual
again).
III. Mon
itoring goals
Consultants will encourage clinicians to monitor how veterans are progressing
toward their goals. Consultants will ask clinicians to monitor the goal of at least one
veteran during SST group participation. This ongoing process is important for a
variety of reasons: (1) it helps establish that the goal(s) developed are reasonable
and attainable or if the goal(s) need to be revised; (2) monitors when veterans
succeed in reaching goal(s) and need to develop new one(s); (3) monitors when a
goal should be modified based on repeated problems reaching a goal; and (4)
monitors when veterans want to change or amend their goals.
Goal monitoring can occur in several different ways. The Bellack et al., (2004)
Social Skills book includes worksheets that can be used both by clinician and
veterans to monitor how each veteran is doing with the goals they established (see
Page 316 for the Social Skills Goals Self-Rating Scale and Page 317 for the Social
Skills Goals Clinician Rating Scale). Clinicians may also choose to use the Goal
Attainment Scaling system to establish and monitor goals. Clinicians may choose to
monitor goals using solely verbal methods of checking in. Clinicians may find it
most useful to monitor goals of veterans briefly at the beginning of group on a
regular basis (e.g., monthly basis). Clinicians may also choose to have regular,
brief individual sessions with the veterans to check in about how the group is going
and to monitor progress toward SST goals.
22
VA Social Skills Training for Serious Mental Illness
SOCIAL SKILLS GROUP OBSERVATION CHECKLIST
Group Leader: Date:
Consultant:
Instructions: Complete this checklist after observing the group leader conduct a session. For
each item, check off whether the group leader performed this skill “not at all”, “partially”, or
“fully.”
General structuring and positive
engagement skills
Not at all
Partially
Fully
Created a warm, welcoming
atmosphere.
Spoke clearly, using a voice neither
overloud nor oversoft.
Established an agenda and
maintained the structure of the
session.
Provided ample positive feedback for
participation.
Redirected group members who
interrupted or strayed from the topic,
using a kind but firm voice.
Asked group members for examples
of personal experiences in which
skills could be or were used.
Used a shaping approach to help
members gradually learn new social
skills by reinforcing small steps
toward the targeted skill.
Encouraged group members to be
actively involved in the session.
(Members can be active in different
ways, such as reading the steps of
the skill out loud, providing a
rationale, providing feedback for role
plays, participating in role plays,
contributing examples of personal
experience.)
(continued)
From Social Skills Training for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
23
VA Social Skills Training for Serious Mental Illness
SOCIAL SKILLS GROUP OBSERVATION CHECKLIST (page 2 of 2)
Steps of social skills training
Not at all
Partially
Fully
Reviewed homework from the
previous group session.
Established a rationale for using the
skill.
Discussed the steps of the skill with
group members.
Modeled the skill in a role-play.
Reviewed the model with the group
members.
Engaged all group members in a
role-play of the skill.
Provided or elicited behaviorally
specific positive feedback for each
group member’s role-play.
Provided or elicited behaviorally
specific suggestions for improvement
for each group member’s role-play.
Assigned specific homework to
practice the skill outside the group.
From Social Skills Training for Schizophrenia (2
nd
ed.) by Alan S. Bellack, Kim T. Mueser, Susan Gingerich, and Julie
Agresta. Copyright 2004 by The Guilford Press. Permission to photocopy this form is granted to purchasers of this
book for personal use only (see copyright page for details).
24
VA Social Skills Training for Serious Mental Illness
Web-Based Consultation Tracking System
The web-based consultation tracking system was designed to serve as an
added component to the consultation experience. Accessible on the
internet, the system is designed to serve as a communication platform
between SST Clinicians and their assigned Consultants. After completing the
workshop, you will receive an email with specific instructions on accessing
the site. Below are instructions for login and use of the system.
NOTE: You must use Internet Explorer to access this system
To login to the system, go to http://cts.evicenter.com
•
Use your email address to login
•
Default password = sst
•
Click the “Continue” button on the right
•
You will be prompted to change your password after you login the
first time. Your password can be anything you want – there are no
restrictions. Remember it for next time!
Upon logging into the system, you will have the option to go into one of 2
main sections (listed in tab-form near the top of the screen):
- Session Data
- Clinician Information
Both of these sections’ functions are described on the following pages. If
you have any questions about the system at anytime, contact Matt Wiley,
Program Coordinator:
Matthew.Wiley@va.gov
(410) 605-7457
25
VA Social Skills Training for Serious Mental Illness
Session Data
Session Data is the main section you will be using. This is the section in
which you can add all new SST sessions, plus view any sessions which have
been reviewed by your assigned consultant. The first screen you will see
after clicking on “Session Data” is your clinician information screen (Name,
site, email address, etc.). There are 3 additional tabs:
- Pending Sessions
- Reviewed Sessions
- Reviewed Sessions with Feedback
Pending Sessions = all new sessions that you enter will be listed here.
If sessions are still pending, then your consultant has not yet reviewed
them. To add a new session, click on the “Add New” link near the top of
the page in this section.
Reviewed Sessions = all sessions that have been reviewed by your
consultant (both “quick-review” and reviewed with feedback)
Reviewed Sessions with Feedback = only lists sessions reviewed by
your consultant with feedback for you
GENERAL NOTES ABOUT SESSIONS:
- If you have indicated that you have recorded a session you will see a
“TRUE” indicator underneath the “Recording” column.
- If you have entered any comments for a session you will see a “TRUE”
indicator underneath the “Comments” column.
IF YOUR SESSION IS RECORDED AND/OR YOU HAVE ENTERED
COMMENTS – YOUR CONSULTANT SHOULD REVIEW WITH FEEDBACK.
TO VIEW YOUR CONSULTANT’S FEEDBACK, CLICK ON THE “REVIEWED
SESSIONS WITH FEEDBACK” TAB, AND THEN CLICK ON THE “REVIEW”
BUTTON NEXT TO THE PARTICULAR SESSION YOU WISH TO VIEW.
THERE WILL BE TIMES THAT YOU WILL NOT RECORD A SESSION AND
YOU WILL HAVE NO COMMENTS – IN THESE CASES, YOUR CONSULTANT
WILL ONLY PERFORM A “QUICK REVIEW”. ALL THIS DOES IS SIMPLY
“MOVE” THE SESSION INTO THE REVIEWED SECTION (BUT HAS NO
FEEDBACK WITH IT – IT IS MERELY A WAY TO ACKNOWLEDGE THAT IT
HAS BEEN REVIEWED AND IS NO LONGER PENDING).
26
VA Social Skills Training for Serious Mental Illness
Clinician Information
Clinician Information is the section in which you can edit your user
information (address, phone number, email, etc.). You may also change
your password here anytime.
27
VA Social Skills Training for Serious Mental Illness
Tips for Entering Information into the Web Based System
(1) Information you enter into the system will be used to facilitate
consultation. Your SST Consultant will listen to the session audiotape
and provide you feedback via the web (in addition to your weekly
consultation calls).
(2) Information needs to be entered in the web-tracking system for each
session regardless if the session is audio-taped or not.
(3) It is recommended to enter the information at least once a week.
(4) If you are co-facilitating a group,
the clinician that
is primary
needs to
enter information for that group.
(5) There should be NO VETERAN PHI (e.g., full names, last names,
etc.) entered into the system.
Specific information to enter:
(1) You will be asked to enter the following information for each
Group Session in the web-system:
o Session Title: Enter the name of the skill covered (e.g., Making
Requests). If you have done the same skill over a few sessions it is
helpful to include the number of times the skill has been completed
(e.g., Making Requests #2).
o Primary Clinician: Enter name of primary therapist
o Secondary Clinician: Enter secondary-therapist; indicate N/A if you
have no secondary therapist
o Recordings Created?: Was the group audio taped? Indicate YES by
checking the box; leave blank if the group was not audio taped.
o If Yes:
Enter Audio
File Name. This can
just
be the name of the
skill as above; it is also helpful
to include the date here (e.g.,
Making Requests #2 07/12/08).
o In the section with the instructions “Below please indicate any
portion(s) of the session you would like consultation on”:
Please mark all sections that you would like additional consultation on.
Please include brief comments about the portion of the group you
would like consultation on.
o Session Date: Enter date the group was conducted (mm/dd/yyyy)
o Duration: Total time of group in minutes (e.g. 45)
o # Veterans Attended: Total number of veterans that attended any
portion of the group
28
VA Social Skills Training for Serious Mental Illness
o Additional Clinician Notes (open ended text): Please include any
specific information that you would like the consultant to know about
that session or any other client-related concerns. This section should
not be written like a clinical note. Rather it should include general
information about the group or any additional areas that could help
facilitate consultation. Again PLEASE DO NOT INCLUDE ANY
VETERAN PHI.
o Once your consultant has had a chance to review your session
information, you will be able to view their feedback in the Consultant
Notes section
(2) You will be asked to enter the following information for each
Individual Goal Setting Session in the web-system:
o Session Title: Enter “Individual Session” and the date (e.g.,
Individual session 06/28/08). You do not have to include the
consecutive number of the individual session. PLEASE DO NOT
INCLUDE VETERAN LAST NAMES IN THE TITLE OR ANYWHERE ELSE IN
THE INDIVDIUAL SESSION INFORMATION.
o Primary Clinician: Enter name of primary therapist
o Secondary Clinician: Enter secondary-therapist; indicate N/A if you
have no secondary therapist
o Recordings Created?: Was the individual session audio taped?
Indicate YES by checking the box; leave blank if the individual session
was not audio taped.
o If Yes: Enter Audio File Name. This can simply be Individual
Session 06/28/08.
o In the section with the instructions “Below please indicate any
portion(s) of the session you would like consultation on”:
Because this section is focused primarily on the groups you can leave
it blank.
o Session Date: Enter date the session was conducted (mm/dd/yyyy)
o Duration: Total time of session in minutes (e.g. 45)
o # Veterans Attended: Enter 1
o Additional Clinician Notes (open ended text): Include the veteran’s
goals established (e.g., Increase work hours from 15 to 20, Make one
new friend in the next 6 weeks, Increase my conversations at the
PRRC to 3 per week, etc.). Please also include any specific information
that you would like the consultant to know about that session or any
other client-related concerns. This section should not be written like a
clinical note. Rather it should include general information about the
session or any additional areas that could help facilitate consultation.
Again DO NOT INCLUDE ANY VETERAN PHI.
29
VA Social Skills Training for Serious Mental Illness
o Once your consultant has had a chance to review your session
information, you will be able to view their feedback in the Consultant
Notes section
30
VA Social Skills Training for Serious Mental Illness
Audio Recording Resources
31
•
VA Social Skills Training for Serious Mental Illness
AUDIO TAPING CONSENT TIPS
•
Consent for audio-taping is voluntary and must be documented.
Have blank standard consents (VA forms10-5345 and 10-3203) prepared for clients
at individual session.
•
Introduce audio-taping as such: “The group social skills sessions are audio-taped.
The reason for this is because I have a consultant that has been doing this type of
group for a while and he/she is going to review the tapes and give me advice on how
I can continue to improve in leading the groups.”
•
If the veteran expresses concerns about the audio-taping, ask what their specific
concerns are and attempt to address them.
•
Be prepared to address common concerns:
o Confidentiality – “The groups are audio-taped so my consultant and the other
clinicians in my consultation group learning how to lead the groups will not
actually be able to see who you are. We will not use last names in the social
skills groups so they will only hear your first name. These recordings will be
destroyed in a relatively short period of time after they are reviewed. Again, the
purpose of the audio taping is for me to continue to improve in leading the social
skills groups.”
o Security
–
“The VA is very concerned
about protecting
and securing
the
health
information of veterans and this project is supported by VA Central Office. Only
my consultant and the
clinicians in my consultation
group
will be able to listen to
the
group recordings. The recordings will be
destroyed in
a relatively short period
of time after reviewing.”
o Judgment (i.e., “What if
I do/say something wrong?) –
“The
purpose
for audio-
taping is so
that I can continue to improve in leading the groups. So
my
consultant is going to be listening to how
I lead the group. You couldn’t say
anything
wrong!”
•
If the veteran wants to participate in the group, but does not want to be audio-taped,
let them know that you will be able to stop audio-taping after about the first six
months of the group and possibly they can participate at that time.
•
Bottom line: Consent for audio-taping is voluntary, but a necessary part of group
membership while you are participating in consultation.
32
a)
Form VHA 10-3203: Consent for Use of Picture and/or Voice
Ea
ch
facil
itator MUST
obtain
approval
from
their local
Privacy Officer
in
order to
send
tapes
to their assigned
SST consultant
VA Social Skills Training for Serious Mental Illness
VA Social Skills Training (VA-SST)
Audio Tape Procedures for
SST Trainees and VA-SST “Consultants”
The VA Social Skills Training program is a VA Central Office (VACO)
sponsored Mental Health Initiative, disseminating evidence-based practices to
mental health clinicians from all VISNs through hands-on, 2-day training
workshops. An important part of this initiative is a 6-month follow-up consultation
period, during which clinician trainees will receive ongoing consultation and
feedback from experienced SST consultants to enhance the overall training
experience. An essential aspect of consultation is the use of audio-taped sessions,
which will be used to provide feedback and fidelity monitoring.
Working closely with VACO, we have established the following audio-taping
procedures (including sending tapes to your VA-SST “consultant” via certified mail).
To be clear, “consultants” are VA employees with expertise in delivering Social
Skills Training.
These procedures are only permitted given that the following steps have been
completed:
1) Proper consent is obta
ined from each veteran participant
- For recor
ding their voice during an SST group
b) Form VHA 10-5345: Request for and Authorization to Release
Medical Records or Health Information
-
For expl
aining th
at this tape (and
tape only) will be delivered to
a
VA-
SST
“consultant” for the sole purpose
of providing
feedback
on the
clinician’s skills
2)
3)
The tape must be sent through
a
mailing
option
that requires
a
signature (i.e.,
FedEx)
33
VA Social Skills Training for Serious Mental Illness
Description of Social Skills Training and the audio-taping & transfer process:
Social Skills Training is not like traditional individual or group psychotherapy
in which there is wide ranging and open discussion of personal matters. It is a
highly structured teaching/training program in which the primary activity is
simulated conversations of hypothetical situations. It is essentially like a class with
a defined curriculum rather a forum for discussion of personal problems and
concerns. First names are used, but there is no other personal information
enunciated during sessions. Further, we are not collecting any personally
identifiable information (PII) from participants, so there is no way for anyone
listening to the tapes to link the first names with specific individuals. Moreover, on
the off chance that some PII is inadvertently mentioned – we encourage clinicians
to destroy the tape immediately rather than forwarding that particular tape to their
SST consultant.
Audio-taped sessions will not contain any PII, as veterans will only be
identified by first names during the recorded sessions. Clinicians will be instructed
to explain to veterans that the purpose of the audio-taping is done solely to help
improve the clinicians’ delivery of SST and that veterans’ identities will not be
disclosed. In the event that any PII is inadvertently disclosed during a taped
session, that tape will not be sent to consultants for review and will be destroyed
immediately. All “sanitized” tapes (containing no patient identifiers) will be sent
from the clinician trainee to their assigned SST consultant for review.
All tapes will be sent directly to the SST clinicians’ assigned SST Consultant
as indicated on the consent forms. Tapes will only be sent using a mailing option
that requires a signature to ensure proper receipt. The audio tapes will be reviewed
by the consultant in order to provide feedback to the trainee. Some tapes may also
be played during group consultation sessions, attended by a group of 4-12 VA
employees who are participating in the training and/or staff of the VA-SST program.
Audio tapes will be destroyed within 2-weeks of review by the consultant,
depending on the scheduling of consultation and subsequent feedback sessions.
Tapes will be destroyed by pulling them out of the cassettes and cutting them into
pieces. When not being reviewed, all tapes will be secured in a locked area (e.g.
locked office, locked file, etc.).
Reminder that all delivered tapes must be “sanitized” (no veteran PHI or
patient identifiers) and will be destroyed after they have been reviewed by
consultants. All tapes that are deemed “un-sanitized” and inappropriate for
delivery will be immediately destroyed by the clinician and not delivered for review.
If there are further questions, please feel free to contact any of the
individuals below.
34
VA Social Skills Training for Serious Mental Illness
Alan S. Bellack, Ph.D., ABPP
Director, VA Social Skills Training for Serious Mental Illness
Director, VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
Baltimore VA Medical Center
(410) 605-7383
Alan.Bellack@va.gov
Bradley E. Karlin, Ph.D.
Director, Psychotherapy Programs
Office of Mental Health Services (116)
VA Central Office
(202) 461-7304
Bradley.Karlin2@va.gov
Matthew T. Wiley, MPH
Program Coordinator, VA Social Skills Training for Serious Mental Illness
VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
Baltimore VA Medical Center
(410) 605-7457
Matthew.Wiley@va.gov
35
•
Place desired tape into the recorder (with recorded side facing out)
•
Press the Play > button
•
Push the CUE >> or REVIEW << button to navigate the recording
•
Use the volume wheel to set desired volume level
•
When done, press the STOP button and eject your tape
VA Social Skills Training for Serious Mental Illness
Sony M100-MC
Audio Voice Recorder
Pre-Set General Settings (Do NOT change):
Mic Mode: Meeting
VOR: O
FF
Fast PB: “Down” position
Tape Speed: 1.2 cm tape speed
BEFORE USING RECORDER:
1) Make sure batteries have enough power (check indicator lights on side of recorder).
There are 3 indicator lights, and all 3 will be lit
at full power.
If top 2 indicator lights are OFF and/or bottom light is flashing: Replace
the batteries before session begins!
2) Make sure Pre-Set General Settings, described at top of page, are at established
levels
If not: make
sure to switch controls for
Mic Mode, VOR, Fast PB, and Tape
Speed to the above
settings!
3) Make sure
you have a new, blank tape inserted
into the recorder (only if recording a
new session)
4) Press the Reset button for the Tape Counter to reset back to 000
TO RECORD A SESSION:
• Place in a front and central location within the session room (preferably on a
table/chair and close to
where
role plays will occur)
• Press the RECORD ● button
o NOTE:
using 1.2 cm tape speed allows 90 minutes of recording time per side
of the audio tape; you
will need to flip the tape and press Record should your
session exceed 90 minutes. (If tape speed is set to 2.4 cm, it only allows 45
minutes of recording time per
side of the audio tape)
• When finished, press the STOP button
and eject
your tape
• Make sure to write the following
information on the tape:
Your
Last
Name
and
Date
of
SST S
ession
• To Record your next session, flip tape to a blank, unused
side or
insert a
new tape
and repeat above steps
TO REVIEW A SESSION:
36
•
•
•
•
VA Social Skills Training for Serious Mental Illness
Preparing for
Facilitating Groups
37
VA Social Skills Training for Serious Mental Illness
DEVELOPING A CURRICULUM
Answering the following questions may start to help you formulate a
curriculum for your SST group:
1. What are some overall goals at my site for the treatment that veterans
receive?
2. What are some common strengths of the veterans that I work with?
3. What are some of the common goals/concerns of veterans that I work
with?
4. What session(s) did I choose in the training that seemed particularly
relevant for my clientele?
5. What domains seem particularly relevant for my clientele (check all that
apply)?
Basic Conversation Skills
Coping with Substance Use
Assertiveness Skills
HIV Prevention
Conflict Management
Developing Romantic/Intimate
Anger Management
Relationships
Using Leisure and Recreation Time
Health Maintenance
Prevocational Skills
Medication Management
Vocational Maintenance
Managing Positive Symptoms
Communal Living Skills
Other:
______________________
Friendship Skills
Other:
______________________
Familial Relationship Skills
Other:
______________________
38
7. Based on those domains, which skills seem important to include?
VA Social Skills Training for Serious Mental Illness
DEVELOPING A CURRICULUM (CONTINUED)
6. Based on the relevant domains, which 4 or 5 seem to have the highest
priority for your clientele?
1.
2.
3.
4.
5.
Curriculum Domain
Skills
1.
2.
3.
4.
5.
39
SAMPLE CURRICULUM DOMAINS
Anger Management
•
Expressing Unpleasant Feelings
•
Leaving Stressful Situations
•
Responding to Untrue Accusations
•
Expressing Angr
y Feelings
•
Disagreeing w
ith Another’s Opinions without Arguing
•
Responding to Unwanted Advice
•
Problem Solving
Coping with Substance Use
•
Offering an Alte
rnative to Using Drugs and Alcohol
•
Refusal Skills – Pusher/Drug
Dealer
•
Requesting that Family Member/Friend Stop Asking You to Use
•
Problem Solving
•
Compromise and Negotiation
Vocational Maintenance Skills
•
Leaving Stressful Situations
•
Listening to Others
•
Following Verbal Instructions
•
Responding to Criticism from a Supervisor
•
Asking for Feedback about Job Performance
•
Joining Ongoing Conversations at Work
•
Disagreeing with A
nothe
r’s Opinion without Arguing
•
Asking for Information
•
Asking for Help
•
Problem So
lving
Communal Liv
ing Skills
•
Locating your Missing Belongings
•
What to do if You Think Someone has Something of Yours
•
Asking for Privacy
•
Checking out your Beliefs
•
Reminding Someone not to Spread Germs
•
Eating and Drinking Politely
*Conflict Management Skills: Compromise and Negotiation, Leaving Stressful Situations, Disagreeing
with Another’s Opinion without Arguing, Responding to Untrue Accusations, Making Apologies
Health Maintenance Skills
•
Making a Doctor’s Appointment on the Phone
•
Asking Questions about Medications
•
Asking Questions about Health-related Concerns
•
Complaining about Medication Side Effects
•
Requesting a Change in your Medication Dosage
•
Asking about a New Medication You Have Heard About
•
VA Social Skills Training for Serious Mental Illness
Reporting Pain and Other Physical Symptoms
40
VA Social Skills Training for Serious Mental Illness
SOCIAL SKILLS TRAINING TASK CHECKLISTS:
IMMEDIATELY AFTER WORKSHOP
Finalize approval with your Privacy Officer.
If not done already, contact your local Privacy Officer using the audio-taping
procedures document emailed to you before the workshop.
See Audio Tape Procedures for SST Facilitators and Consultants (page 33)
Please refer Privacy Officers who have specific questions and concerns to
Matt Wiley, Program Coordinator, at Matthew.Wiley@va.gov or (410) 605 –
7457.
Schedule room for group and/or schedule SST group into program
schedule.
We recommend conducting 2 SST groups per week, lasting 45-60 minutes each.
Each SST group may have between 6-10 group members.
Educate staff about SST group.
You might use Program Description (page 3) or a review article (see
reference list on page 56).
Considering using fliers to educate staff (pages 50-51).
Consider running a “mock” social skills group for staff.
Educate supervisor about consultation process.
Start recruitment.
Complete flyers (if applicable). See Pages 48-49 for sample Veteran fliers
and Pages 50-51 for sample staff fliers.
Attend community meetings to introduce SST group (if applicable).
Education staff as above.
Peruse clinician web-tracking system.
See Page 25 for instructions on accessing and using the system.
Participate in weekly consultation calls.
You will leave the workshop with the name or your consultant and day/time of
your consultation calls.
You will receive an email shortly after the workshop with the VANTS code for
your call.
Read materials
Become familiar with handbook (blue book) resources.
Read SST book (purple book).
Become familiar with the “SS Group Observation Checklist.” (p. 285-286 in
SST Book).
Start discussing curriculum with your consultant
41
VA Social Skills Training for Serious Mental Illness
SOCIAL SKILLS TRAINING TASK CHECKLISTS:
FOR INDIVIDUAL SESSIONS
Individual Goal Setting Sessions:
Conduct individual sessions with each SST group participant.
Use handouts to guide you through individual goal setting sessions.
“Guidelines for Individual Sessions” (page 9)
“Brief Goal Assessment” (page 10)
“Group Expectations” (page 11)
Check audio recorder settings and conduct a test recording. See Audio Voice
Recorder – User Instructions (page 36).
Do not turn on the audio recorder until veteran has signed consent forms. See
Audio Taping Consent Tips (page 32).
Audio record one individual goal setting session* and immediately send
audiotape to consultant.
Write CPRS note. See Clinical Note Template – Individual session for example
(page 53).
Enter information about veterans’ individual goals for each individual session
regardless of if that session was audio-taped or not. See Web-based
Consultation Tracking System (page 25) and Tips for Entering Information into
the Web Based System (page 28).
*Consultant may request to hear more than one individual goal setting session
audiotape.
42
VA Social Skills Training for Serious Mental Illness
SOCIAL SKILLS TRAINING TASK CHECKLISTS:
FOR GROUP SST SESSIONS
Before Conducting SST Group Sessions:
Review “Group Session Sequence.” (p. 49 in SST book)
Prepare for SST group session.
Review skill in SST book Part II (starting p. 193) including reading
rationale, becoming familiar with steps, reading sample role play
scenarios, and special considerations.
Copy handouts with skill title and steps only (recommend not distributing
skill handouts with special considerations section).
Prepare and copy homework sheets.
Assign leaders to primary and secondary (if have two leaders). This will alternate
if both of you attended workshop.
Discuss tasks and roles related to primary and secondary group leaders
(p. 83 in SST book).
Prepare room (e.g., chairs in semi-circle facing board, prop flip chart/dry erase
board).
Check audio recorder settings and conduct a test recording.
After SST Group Sessions:
Write CPRS note. See Clinical Note Template – Group session for example
(page 54).
Primary leader enters group session note into clinician web-tracking system.
Consultant will provide group leader with feedback after audiotapes are
reviewed. See Web-based Consultation Tracking System (page 25) and Tips for
Entering Information into the Web Based System (page 28).
Label audiotapes with the following information:
o Date of group session
o Name of skill taught
o Primary group leader’s name
Place audiotape into a letter-size envelope before placing inside a FED EX
envelope/package.
Send audiotape as soon as possible in order to receive timely feedback from
consultant.
General information:
Confidentiality – do not use last names during group session. If PHI is recorded,
DESTROY tape.
Audio record one session per tape.
Contact Matt Wiley (Matthew.Wiley@va.gov) for SST supplies (e.g., audiotapes,
batteries, flipchart, etc.)
In order to successfully complete the SS training, group leaders must enter session
notes into clinician web-tracking system and participate in the weekly consultation
phone calls for the 6-month time period.
43
VA Social Skills Training for Serious Mental Illness
MATERIAL AND PRACTICAL NEEDS
This section focuses on the practical and material resources you need to run
a social skills group. Please take a moment and check if you have the
resources available to you under Column A. If you do not currently have a
resource available, please consider the corresponding question/statement in
Column B.
Column A
Column B
Group room with chairs
Who you could ask about reserving a room
two times a week for 1.5 hours?
Dry erase board or
flipchart and markers
Contact Matt Wiley (Program Coordinator)
at
Matthew.Wiley@va.gov
about supplies.
Xerox machine for
Handouts and Homework
Where is the closest copy machine that
you can use?
Computer/internet
access
Can you speak with your supervisor and
your local IT department about gaining
access you need?
Time (before and after
group – see Clinician
Checklist)
What are some ideas about securing
necessary time? If you are having
concerns around time, be sure to discuss
with your consultant!
44
VA Social Skills Training for Serious Mental Illness
IMPORTANT PAGES IN THE SST BOOK
The following is a reference list of pages in Bellack, A.S., Mueser, K.,
Gingerich, S., & Agresta, J. (2004) Social Skills Training for Schizophrenia
that you should find most helpful when starting and running Social Skills
Groups:
Resources for Planning SST Groups
Page 82 Selecting Group Leaders (qualities of effective group leaders)
Page 83 Roles of Primary and Secondary group leaders
Page 92 Developing a SST Curriculum
Page 193 Skill Sheet Table of Contents
Resources for Facilitating SST Groups
Page 114 Chapter 8: Troubleshooting: Common Problems and Challenging
Clients
Page 117 How to handle when Veterans are reluctant to Role-Play
Page 120 and 123 Dealing with common problems in SST groups
Page 186 General tips for SST
Page 281 Detailed outline of SST group session sequence
Page 317 Social Skills Clinician Rating
Scale (tool for monitoring SST goals)
Individual Sessions/ Goal Setting and Monitoring Resources
Page 85 Individual Goal Assessment (brief measure that can be used to
establish SST goals)
Page 101 Developing and
using SST goals
Page 279 SST Orientation for clients
Page 287 Guidelines/Expectations for SST group members
Page 295 Social Functioning Interview
Page 298 Social Adaptive Functioning
Evaluation (SAFE)
Page 316 Social Skills Goals Self-Rating Scale
Page 317 Social Skills Goals Clinician Rating Scale
Consultation Resources
Page 285 Social Skills Group Observation Checklist
45
VA Social Skills Training for Serious Mental Illness
RECRUITM
ENT PLANNING
Recruitment:
How you choose to recruit veterans for your social skills group will likely vary
depending on the type of site you work in. For example, recruitment will be
different if you work in a Psychosocial Rehabilitation and Recovery Center
(PRRC) versus a CBOC. If you work in a PRRC, there may already be a
structure in place to start a twice-weekly group. For example, you may add
another group to an existing schedule or you may choose to replace another
group you already lead. If you work in a CBOC you may have to be more
active in hanging fliers and talking with providers about potential group
members.
Group Discussion:
•
How will you recruit veterans for a social skills group at your site?
•
Do you foresee any “speed bumps” for recruitment at your site? If so,
what are they?
•
Do you foresee having an “open” or “closed” group? What are the
reason(s) behind this?
•
Based on the Group Discussion, what are some strategies to overcome
these “speed bumps?”
Ideas for recruitment:
•
Put up fliers at my site (See Handbook: Example Recruitment Flier for
Patien
ts – Open group; Example Recruitment Flier for Patients – Closed
group)
•
Attend treatment team meetings and discuss groups (See Handbook:
Example Treatment Team Handouts)
•
Do a mock SST session at a Community Meeting
•
Email announcements to mental health staff
•
Announcement or article in Newsletters
•
Others?
46
VA Social Skills Training for Serious Mental Illness
Recruitment Resources
47
VA Social Skills Training for Serious Mental Illness
EXAMPLE RECRUITMENT FLIER FOR PATIENTS – OPEN GROUP
T
T
u
u
e
e
s
s
d
d
a
a
y
y
s
s
a
a
n
n
d
d
T
T
h
h
u
u
r
r
s
s
d
d
a
a
y
y
s
s
3
3
:
:
0
0
0
0
p
p
m
m
–
–
4
4
:
:
3
3
0
0
p
p
m
m
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o
m
m
2
2
1
1
3
3
B
B
The group is designed to teach
veterans with mental illness ways
to improve their social skills.
Interested? Call one of the group leaders or ask
your mental health provider to make a referral.
Group Leaders:
Charlie Clinician (222-5555)
Frieda Facilitator (222-5556)
Basic information:
•
The group focuses on Basic Conversation Skills, Anger
Management Skills, and Vocational Skills
•
The groups are small and highly structured and can be a lot of
fun!
48
Introducing a new
group in the Mental
Health Clinic: Social
Skills Training
VA Social Skills Training for Serious Mental Illness
EXAMPLE RECRUITMENT FLIER FOR PATIENTS – CLOSED GROUP
Are you interested in
a group
focused on teaching
social skills?
The purpose of this group is for veterans to learn ways to
improve interpersonal skills and make it easier to get along
with others.
Group
Leaders:
Charlie Clinician
(X5555)
Frieda Facilitator
(X5556)
We will focus on:
Groups held:
Tuesdays &
Thursdays
3pm to 4:30pm
Room 213B
•
Basic Conversation Skills
•
•
Anger Management
Skills Vocational Skills
ELI
GIBILITY:
In order to be eligible a veteran must have a
diagnosis of a mental illness (e.g., schizophrenia,
schizoaffective disorder, bipolar disorder, etc.).
TIME/PLACE:
The groups will be held Tuesday and Thursday
afternoons from 3pm to 4:30pm on the second floor (room
213B).
INTERESTED??? C
all Mr. Clinician (222-5555) or Ms.
Facilitator (222-5556) or ask your mental health
provider to make a referral.
Spaces are limited and the
group is only open to new
members until May 24!!!!!!
The PRRC is offering Social Skills
Training groups to Veterans with
Mental Illness
VA Social Skills Training for Serious Mental Illness
EXAMPLE TREATMENT TEAM HANDOUT
Social Skills Training for
Serious Mental Illness
Tuesdays and Thursdays
3:00pm – 4:30pm
Room 213B
Group Leader:
Charlie Clinician (X5555)
Do you work with a
veteran that might benefit
from social skills training?
Basic information:
•
This group is designed to help veterans with serious mental
illness improve their social skills
•
The curriculum focuses on:
o Basic Conversation Skills
o Anger Management Skills
o Vocational Skills
•
The groups are small and highly structured
Referral Procedure:
1. Call Charlie Clinician at ext. 5555 with the veterans contact
information
2. Mr. Clinician will call the veteran and set up an individual
meeting prior to starting the group
50
VA Social Skills Training for Serious Mental Illness
EXAMPLE TREATMENT TEAM HANDOUT
Social Skills Training for
Serious Mental Illness
We would like to introduce a new treatment opportunity for
veterans with serious mental illness (SMI) p rovided in the
PRRC – Social S kills Training group.
The purpose of this highly structured Social Skills group is for
veterans with SMI to learn ways to improve interpersonal
skills and make it easier to get along with others. The main
way participants practice new skills is through role-plays and
getting hel pful and p ositive feedback from the group.
•
•
•
Basic Conversation Skills
Anger Management Skills
Vocational Skills
ELIGIBILITY: In
order to be eligible for the Social Skills groups
a veteran must have a diagnosis of a serious mental illness
(e.g., schizophrenia, schizoaffective disorder, bipolar disorder,
treatment refractory depression).
TIME/PLACE: T
he groups will be held Tuesday and Thursday
afternoons from 3pm to 4:30pm on the second floor (room
213B).
REFERRAL PROCEDURE: (1
) Call one of the group leaders at
the extensions to the left with the veteran’s contact
information. (2) The leaders will call the veteran and set up an
individual meeting p rior to starting th e group.
Social Skills
Clinicians:
Charlie Clinician
(X5555)
Frieda Facilitator
(X5556)
The curriculum for this group will focus on:
Groups held:
Tuesdays &
Thursdays
3pm to 4:30pm
Room 213B
51
VA Social Skills Training for Serious Mental Illness
Clinical Notes Resources
52
VA Social Skills Training for Serious Mental Illness
EXAMPLE CLINICAL NOTE TEMPLATE – INDIVIDUAL SESSIONS
Social Skills Training Goal Setting Session – PRRC
Date of session: 11/17/08
Time of session: 3 pm
Length of session in minutes: 45 minutes
Session Content: Introduced Social Skills Group facilitator
(writer), discussed purpose and general format of social skills
groups, and discussed group expectations. Veteran was provided
the opportunity to have questions answered and/or concerns
addressed. Veteran stated that he did not have any questions or
concerns at this time. During this session the veteran completed
a brief goal assessment with writer and set 2 treatment goals
for social skills group including: increasing work hours from 15
per week to 20 per week and “getting along” with group home
residents. Veteran was provided with handout with group
information (i.e., name of facilitator, contact information,
group setting information). Veteran is scheduled to start group
on 5/21/08.
Consent Information: Writer explained that the group social
skills sessions are audio-taped because a consultant will review
the tapes of the groups and give writer advice on how to improve
in leading the groups. Also explained how the recordings are
stored and that the consultation sessions are in group format.
The veteran signed consent for release of PHI to consultant (VA
Form 10-5345) and for his audio-taped voice to be released to
the consultant for training (VA Form 10-3203). Veteran was
provided the opportunity to have any questions answered and
concerns addressed regarding the consent process. He stated that
did not have any questions or concerns at this time.
Behavioral observations: The veteran smiled several times during
the session and stated that he was looking forward to starting
the group.
General participation: The veteran was an active participant in
the session. Although he did not have questions about the group
or consent for audio-taping he provided information around goals
and social functioning.
53
VA Social Skills Training for Serious Mental Illness
EXAMPLE CLINICAL NOTE TEMPLATE – GROUP SESSIONS
Social Skills Training Group – Mental Health Clinic
Title of Skill: Asking Questions about Health Related Concerns
Date of group: 11/21/08
Time of group: 3pm
Length of group in minutes: 90
Length of time veteran spent in group: 90
Number of veterans present in group: 6
Number of role-plays veteran participated in: 3
Homework from last session: _X_Completed
___Partially Completed
___Not Completed
Behavioral observations: Veteran presented with a bright affect
and smiled several times during group.
General participation: Veteran was an active participant in the
group. He volunteered to complete role-plays, responded to
questions, and provided helpful and appropriate feedback to
other group members. He role-played asking his primary care
physician about sleep-related concerns and stated that he plans
on using the skill at next doctors appointment.
54
VA Social Skills Training for Serious Mental Illness
Additional Resources
55
VA Social Skills Training for Serious Mental Illness
REFERENCE LIST FOR SOCIAL SKILLS TRAINING
Bellack, A.S. (2004). Skills training for people with severe mental illness.
Psychiatric Rehabilitation Journal, 27, 375-391.
Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social
skills training for schizophrenia: A step-by-step guide. 2nd Edition. New
York, NY: The Guilford Press.
Kurtz, M.M. & Mueser, K.T. (2008). Meta-analysis of controlled research on
social skills training for schizophrenia. Journal of Consulting and Clinical
Psychology, 76, 491-504.
Lehman, A.F., et. al. (2004). The Schizophrenia Patient Outcomes Research
Team (PORT): Updated Treatment Recommendations 2003. Schizophrenia
Bulletin, 30, 193-217.
Tenhula, W.N. & Bellack, A.S. (2008) Social Skills Training. In K. Mueser &
D. Jeste (Eds.) Clinical Handbook of Schizophrenia. Guilford Press, New
York.
56
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