A Role Development Intervention for Persons With Schizophrenia

Role development is a theory-based intervention designed to assist persons who have a diagnosis of schizophrenia to develop social roles, including the task and interpersonal skills underlying these roles. The overwhelming effects of the symptoms of schizophrenia can affect a person's ability to develop or maintain such social roles as family member, worker, community member, student, and friend. Health care practitioners who are trained in the use of role development can help clients identify and develop roles and skills that are meaningful to them.

Role development has four components: a theoretical base, a description of functional and dysfunctional behavior within roles and skills, assessments to evaluate roles and skills, and methods to promote positive change. The theoretical base is founded on principles in role theory and social learning theory. Descriptions of functional and dysfunctional behavior and assessments to evaluate these behaviors have been developed for seven roles and their associated task and interpersonal skills. The methods to promote positive change provide guidelines for choosing appropriate activities, interactions, and modifications to the environment.

To implement role development, the practitioner conducts an interview with the client to determine the roles and skills the client would like to address. The practitioner then observes the client and completes the appropriate assessments for skills and roles on the basis of the observation and interview. Next, the practitioner develops a treatment plan in collaboration with the client, which includes the roles and skills to be addressed as well as specific activities and interactions for promoting change. The practitioner and the client discuss the client's progress on a weekly basis and develop a plan for the coming week. The practitioner documents a weekly progress report, and modifications to the treatment plan are made accordingly.

A research study was conducted to determine whether adults with schizophrenia who resided in a forensic setting demonstrated better task and interpersonal skills and social roles when they were involved in an individualized intervention based on role development compared with an intervention based on a multidepartmental activity program. Although the development of roles may be viewed as more appropriate for clients in community settings, this study was conducted to determine whether clients in a forensic setting demonstrated an interest in developing roles and an ability to do so.

The study was conducted from May 2000 to June 2001. The clients who participated in the study were men aged 18 to 55 years who had a diagnosis of a schizophrenia-spectrum disorder and who were receiving antipsychotic medication. A total of 84 clients were admitted to the study, 42 participants each in the experimental group and the comparison group. No participants withdrew from the study. Eighteen staff from the rehabilitation department participated in the role development training and implementation. Training occurred over a period of ten weeks, for a total of 15.5 hours. Roles for this study were limited to those an individual could develop in this forensic setting—for example, worker, student, group member, or friend.

All clients participated in programs daily for four hours a day. Clients in the multidepartmental activity program participated in nonindividualized therapeutic interventions designed to encourage socialization and the productive use of time. The intervention was group oriented and was not structured to address the development of individual social roles or the specific skills that are nested in these roles.

Quantitative and qualitative measures were used to collect data. The study used a repeated-measures pretest-posttest design. Participants in both groups were evaluated with four instruments that assessed role and skill functioning on admission to the study and after four, eight, and 12 weeks of participation. Independent raters, blinded to the purpose of the study, conducted the initial and repeated measures of functioning. Qualitative measures included client interviews and staff focus groups. Once the experimental group began, staff were monitored biweekly for fidelity to the intervention via completion of fidelity checklists.

No demographic differences were noted between participants in the experimental group and those in the comparison group. Within-group tests, between-group tests, analysis of covariance, multivariate analysis of variance, and repeated-measures analysis of variance were conducted. Data analysis indicated that participants in the role development program showed statistically significant improvement (p<.05) in the development of task skills, interpersonal skills, and role functioning, especially at four weeks of treatment, compared with participants in the multidepartmental activity program. Qualitative data from staff focus groups and patient interviews supported these findings. Although both groups indicated that the rehabilitation program was a positive aspect of their hospitalization, only the participants in the role development program could cite specific skills and roles they learned and ways in which these skills and roles could transfer to other life situations.

Dr. Schindler is assistant professor of occupational therapy at the Richard Stockton College of New Jersey, P.O. Box 195, Pomona, New Jersey 08240 (e-mail, [email protected]).