Objective: The authors compared the community functioning of outpatients with persistent
forms of schizophrenia after treatment with psychosocial occupational therapy or social
skills training, with the latter conducted by paraprofessionals. Method: Eighty outpatients
with persistent forms of schizophrenia were randomly assigned to receive either psychosocial
occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18
months of follow-up with case management in the community. Antipsychotic medication was
prescribed through “doctor’s choice” by psychiatrists who were blind to the psychosocial
treatment assignments. Results: Patients who received skills training showed significantly
greater independent living skills during a 2-year follow-up of everyday community functioning.
Conclusions: 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.