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Developing Skills and Supports for Goal Success

Overview
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In this phase of psychiatric rehabilitation, the practitioner has already worked with the participant to set a life goal and identify the critical skills and supports necessary for success and satisfaction in attaining a life goal.
The goal of this step is to help practitioners understand how to work with individuals to learn and use skills and supports necessary to keep their life goal.
It is important to note, there is a difference between someone not knowing a skill and having barriers to doing the skill.

Foundational Concepts

The Psychiatric Rehabilitation practitioner continues to use both orienting and active listening skills to partner with the participant throughout each step of the Psychiatric Rehabilitation process. The concepts and skills of active listening and orienting are fundamental to Psychiatric Rehabilitation. Click below to learn more about the steps to the skills of orienting and active listening.

Orienting
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Active Listening
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Orienting 

Steps include:

  1. Name the activity
  2. Show the participant what the process looks like by showing an example and explaining it.
  3. Discuss how it might be helpful to the participant.
    Identify what the participant can expect the practitioner to do; and
  4. Identify what the participant will be asked to do in order to successfully participate.
  5. Ask the participant to repeat back, in their own words, what they heard you explain.

Active Listening

Steps include:

  1. Includes all three skills associated with empathically responding to the participant’s perspective.

  2.   a. Listening for content (i.e. What they said)

      b. Listening for feeling (i.e. “Sounds like you’re feeling….is that correct?”

      c. Listening for feeling and meaning (i.e. “Sounds like you’re frustrated and don’t want to live there anymore, is that correct?”)

  3. The practitioner checks in with the participant to ensure they have accurately understood the participant’s perspective.

  4. Practitioner avoids advice giving, judging, or directing the conversation away from the participant’s perspective.

Teaching Skills

Teaching Skills is a systematic approach practitioners can use when someone doesn’t know a skill. This is different than the participant having barriers to skill use, which will be addressed later. There are three parts to teaching a skill:

  • Outline Teaching Content
  • Organize it for Teaching
  • Deliver the Content
instructor teaching in person class

Teaching Skills (Part 1: Outline Teaching Content)

Outline teaching content is creating a summary of the critical knowledge that the person needs to successfully learn a skill. This includes knowledge of what the skill is, benefits, behaviors, and conditions for when it’s used.

There are four parts to Outlining Teaching Content: 

  1. Definition – What it is: States in simple language what the skill name means (i.e., what someone DOES when they perform the skill.) 
  2. Benefit – Why it’s important: Describes how using the skill helps the person in real life. 
  3. Critical Behaviors – How to do it: Identifies three or four important behavioral actions needed to perform the overall skill. 
  4. Performance Condition – When to use it: Identifies what situation(s) trigger the use of the skill in general.
person writing

Teaching Skills (Part 2: Organize it for Teaching)

Organize for teaching means to prepare or modify an existing “lesson plan” based on the elements in the Content Outline, using a specific instructional structure.

The structure that we use is ROPES. 

Review – Discusses and explores the learner’s experience and understanding of the skill. 

Overview – Presents the general image of the skill by discussing the content outline and providing an example of the entire skill. 

Presentation – Instructs learners about each critical behavior through Tell-Show-Do. 

  1. Tell – Provide knowledge of skill or behavior. 
  2. Show – Provide examples of process or product (role play, photo, video).
  3. Do – Activity that allows the person to try the skill with worksheets, performance checklists, etc.

Exercise – Provides practice of integrating all critical skills together with feedback. 

Summary – Review the learner’s understanding of the skill.

group of learners raising hands

Teaching Skills (Part 3: Deliver the Content)

Partnering with the individual to identify what areas of readiness they want to develop, strategies that will be used to develop readiness and how to implement the strategies.

The feedback loop includes sharing overall impressions, what was done well, and one specific recommendation for improvement. While the steps are the same for individual sessions and groups, there are some important differences. These differences are noted below: 

  • Individual Lessons: Use a range of Partnering Skills during ROPES including demonstrate an understanding of the person’s knowledge or experience and summarize learning. Use partnering skills of active listening skills to respond to the person’s self-feedback and reactions.

     

  • Group Lessons: Use Partnering Skills and summarize the group’s feelings and responses during ROPES, especially at the end of the Review, Presentation, and Exercise sections. 

 

 

Individual

Group

Review

  • Demonstrate understanding of a person’s knowledge 
  • If there is time, do the individual step with each person 
  • Then, summarize the overall level of knowledge and themes, linking it to what will be taught. 

Overview

  • When discussing the benefit, link to the experience shared in “Review.” 
  • When discussing the benefit, link to the overall group experience shared in “Review.” 

Presentation

  • Respond to answers given from questions asked. 
  • When the “DO” from Tell-Show-Do is done, summarize the learning.
  • Summarize group answers when you ask questions. 
  • When the “DO” from Tell-Show-Do is done, summarize the group learning, 

Exercise

  • Respond when self-feedback is provided. 
  • Respond to reactions when giving feedback. Summarize what the person will do differently next time. 
  • Respond when self-feedback is provided. 
  • Respond to reactions when giving feedback. 
  • Summarize group strengths and what will overall be done differently next time. 

Summary 

  • Ask the person what they remember about the definition, benefit, critical behaviors, and performance condition. 
  • Respond to what they say. 
  • Add or rephrase anything that is missing or incorrect. 
  • Ask the group members what they remember about the definition, benefit, critical behaviors, and performance condition. 
  • Respond to each person who answers. Summarize what the group told you, then add or rephrase anything that is missing or incorrect.
team meeting with happy people clapping

Promoting Skill Use

Promoting skill use is used when a person has a skill but has a barrier to performing the skill in the ways needed for success and satisfaction in the desired life goal. Here, the practitioner supports the participant in developing a step-by-step action plan to overcome barriers that prevent the person from using the skill when it is needed, with whom it is needed, as often as it is needed. The skills worked on are from the list of critical skills previously determined.

There are three steps in Promoting Skill Use:

  • Identify Barriers
  • Create an Action Plan
  • Match Barrier to the Action Step 

This step is about clarifying what it means to correctly perform the skill and understanding the reasons for not doing the skill successfully. There are four kinds of barriers to doing a skill: 

  1. Lack of Confidence – Lacking the belief that the barrier can be overcome.
  2. Lack of Knowledge – Lacking the understanding of how to overcome the barrier.
  3. Lack of Thinking Ahead/Forethought – Lacking the planning to be sure the resources are available to complete the task when it needs to be done. 
  4. Lack of Resources – Lack of resources needed to complete the task. 

 

* These are common barriers to promoting skill use. Mental health barriers also exist at times and working collaboratively with other practitioners may be part of someone’s action plan.

This step is developing a set of sequential steps to overcome barriers. 

Five types of action steps can be utilized to overcome identified barriers: 

  1. Resource Acquisition – Steps to get the people, places, or things they need to use the skill. 
  2. Research – Steps to obtain the information needed. 
  3. Planning – Arrange ahead of time to use the skill. 
  4. Rehearsal – Mentally or behaviorally practice the behavior to perform the skill as needed.
  5. Successive Approximation – Practice steps in increasing similarity to frequency and circumstance.

The third step in the “Promoting Skill Use” process is to match the Barrier to the correct type of Action Step.

See the table below for which Action Steps match with which Barrier:

Barriers 

Action Step

Lack of Confidence

Rehearsal, Research, Successive Approximation

Lack of Knowledge 

Research

Lack of Thinking Ahead

Planning, Rehearsal 

Lack of Resources

Resource Acquisition 

It’s important to encourage someone by figuring out how  they can overcome challenges. To do this, identify the steps they find difficult or are unsure about. Once you have done this, you can find the right incentives and reminders to help motivate people to take action. There are three types of incentives: 

  1. Timelines – Start dates and/or end dates help prompt action. 
  2. Reinforcers – The person can control and personalize their desired types of rewards. 
  3. Monitoring – Provides internal and external checkpoints to help the person stay on track. 

* Once you add these to the specific steps, review the entire plan with the person.

group of people putting puzzle together

Promoting Resources/Support

Promoting Support Use is developing a step-by-step action plan to overcome barriers that prevent the use of a specific resource, at the needed level of frequency, that is critical to achieving the Life Goal.

There are three ways to promote support use:

Part 1: Plan for Resource Utilization

Part 2: Market for Access 

Part 3: Link/Modify for Use 

Plan for Resource Utilization means identifying solutions to barriers to access and/or utilization of the needed support. Use partnering and active listening skills to identify them. If barriers to access or utilization exist you may try these solutions.

  1. Market the person to a resource (promoting that they are a better fit than perceived). 
  2. Link the person to the resource as is. 
  3. Modify the resource to increase its ability to provide support.

 

If there are no barriers, just link the person to the resource or remind the resource to provide its support.

women writing

Promoting Resources/Support: (Part 2: Market for Access)

Promoting Support Use is developing a step-by-step action plan to overcome barriers that prevent the use of a specific resource, at the needed level of frequency, that is critical to achieving the Life Goal.

This process involves highlighting a person’s suitability for a resource to secure their access to the necessary support or service. It often includes advocating with those who control entry. When promoting access, it’s important to know who to communicate with and when.There are three strategies to try:

  1. Turn a liability into an asset: Present objectionable characteristics in a positive light. Ex: John may have used drugs in the past but his rehabilitation experiences have made him committed to not using drugs now.
  2. Compensate for a liability: Give added information that balances out or negates objections. Ex: Yes, he has a history of a psychiatric condition, but his friendly demeanor will help him make friends in the group.
  3. Deny liability is a liability: Give information that contradicts the objections. Ex: John will use his case manager and residential staff for rehabilitation support, not the instructor.

Once the objection has been overcome, it is important that we follow up later to confirm that the person was able to access the support. We want to make sure that it actually happened. If it hasn’t been followed through on, recycle the previous three steps as needed.

person typing on laptop

Promoting Resources/Support: (Part 3: Link/Modify for Use)

This is the process of ensuring that the person is connected with a resource that is available, able, and willing to provide the support needed to achieve the life goal. Promoting skill use through linkage is the process of connecting a person with a resource. Modifying for use is the process of negotiating a change in the features of the service or resource or how it is provided.

There are four types of barriers to support use. Barriers to utilizing the support can be experienced by either the resource/support, the person, or both. Four types of barriers to utilization are: 

  1. Emotional – Negative feelings or attitudes 
  2. Knowledge – Lack of information or facts 
  3. Skill – Lack of physical, emotional, or intellectual skills. 
  4. Resource – Lack of people, time, materials, or special features, etc.

Action Plan

Work with the person to create an action plan to help the person either link to or use a support/resource.

When negotiating with supports, it is important to focus on the shared interests and address any conflicting interests of each participant. When you are negotiating, you want to create a solution that has something for everyone. Everyone’s needs must be addressed in some way.

 

Action Plans for Linking 

Action Plans for Support/Resource Use

1. Requires agreement with the person receiving services. 

2. Begins with an action verb. 

3. Written concisely in easy to understand language. 

4. Limited number of major steps (not more than 5 steps).

 1. A method of increasing the person’s ability to use the support offered. 

2. It requires only the behaviors that are in the individual’s repertoire. 

3. Begins with an action verb. 

4. Written concisely in easy to understand language with the last step being confirmed provision of services to the person. 

5. Limited number of steps ( average 3-5).

Key Points: Developing Skills and Supports for Goal Success

Developing Skills and Supports is a process that helps the person learn or improve their use of needed skills and acquisition of needed supports which are essential to achieving their life goal.
Key Point
Key Point1
Skills, by definition, can be learned and taught.
Key Point
Key Point 2
Skills Teaching should be done with a person when they do not have the skill-not when they have the skill and don’t use it. We support the person through a process that fully orients the person to what the skill is, when to use it, and its benefit to the person. The specific concrete behavioral steps needed to perform the skill are described, demonstrated, and practiced with feedback.
Key Point
Key Point3
We focus on teaching the skills that have been identified as critical to achieving a person’s life goal.
Key Point
Key Point4
The ROPES structure, including Tell-Show-Do, is designed to maximize a person’s learning by addressing multiple learning modalities (auditory, visual, etc.) as well providing a step-by-step structure.
Key Point
Key Point5
Promoting Skill Use is used when a known skill isn’t being performed to the needed level. It helps identify barriers to skill use and strategize ways to address them. It uses a step-by-step action plan that prepares the person to use the targeted skill as needed
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Key Point6
There are three steps to Promoting Skill Use: 1) Identifying Barriers; 2) Developing the Action Plan; 3) Supporting Individual Action
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Key Point7
There are four main types of barriers to skill use. They are: 1) Lack of Confidence; 2) Lack of Knowledge; 3) Lack of Thinking Ahead; 4) Lack of Resources
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Key Point8
There are five common types of action steps to address barriers to skill use. They are: 1) resource acquisition, 2) research, 3) planning, 4) rehearsal and 5) successive approximation.
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Key Point9
A Skill Use Plan takes the person from the level of skill use they currently have, to being able to perform the skill successfully in the Life Goal environment. In this way, the detailed, systematic plan is one of the most effective ways of turning a Life Goal that is aspirational into a practical and achievable goal.
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Key Point10
Promoting Support Use creates an action plan to overcome the barriers to access or use the needed resource.
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Key Point11
The provider’s role in helping people get the resources/supports they need goes beyond referring people to community resources. It often requires marketing and negotiating modifications with or on behalf of the person.
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Key Point12

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