Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy. (Am J Psychiatry 1998; 155:1087–1091)
While the efficacy of social skills training in schizophrenia appears well established (R1558161–R1558168), most studies have been conducted in medical school departments of psychiatry with augmented staff who were specially prepared as trainers. Moreover, most of the efficacy trials have used "customary treatment" as the control group. Three major questions that remain largely unanswered are, Can social skills training be effectively conducted by paraprofessionals in an ordinary clinical setting? Do the skills learned in clinic training sessions generalize to the outside world? and Are the effects of skills training discernible when an active comparison group is used?
In most psychiatric hospitals and day hospitals, the prevailing psychosocial treatment is occupational therapy in which expressive art and crafts and recreational activities are the media through which therapists build self-esteem and productivity. However, there have been few empirical evaluations of the efficacy of this approach (R1558169). At the West Los Angeles Veterans Administration (VA) Medical Center, hundreds of patients with serious mental disorders receive this modality each year. In 1981, the VA Central Office established a new form of psychosocial treatment by funding a demonstration program, at the West Los Angeles VA Medical Center, for training in social and independent living skills. Subsequently, a health services research study was begun at this medical center to compare the relative impact of occupational therapy and skills training on persons with persistent and long-term schizophrenia. We shall report the first results from this study in the present article.