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Assessment of the Long-Term Benefits of Life Skills Programming on Psychosocial Adjustment

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Title: Assessment of the Long-Term Benefits of Life Skills Programming on Psychosocial Adjustment
Language: English
Authors: Sharma, Ruby, Reddon, John R., Hoglin, Brenda
Source: Journal of Offender Rehabilitation. 2008 47(1-2):121-137.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Physical Description: PDF
Page Count: 17
Publication Date: 2008
Document Type: Journal Articles
Reports - Evaluative
Education Level: Adult Education
Descriptors: Daily Living Skills, Training, Adjustment (to Environment), Adults, Mental Disorders, Gender Differences, Program Effectiveness, Comparative Analysis
DOI: 10.1080/10509670801940987
ISSN: 1050-9674
Abstract: The durability of the psychosocial benefits of Life Skills programming on outpatient adults with mental health/forensic issues was examined. Participants were 52 adults (28 males, 24 females) who completed 16 weeks of Life Skills at a psychiatric outpatient clinic and were re-assessed between six months and six years following treatment. Psychosocial adjustment was assessed using the three scales of the Holden Psychological Screening Inventory (HPSI). Two groups of participants were compared, based on time since completion of treatment. There were no significant differences between time-based groups on the HPSI, but there was a significant gender effect for psychiatric symptoms, with females scoring higher on this scale than males (p = 0.028). When current HPSI scores were compared to HPSI scores that were assessed upon completion of Life Skills in a recent pre-post study on the same clientele (Reddon, Hoglin, & Woodman, 2008), analyses produced no statistically significant differences between follow-up HPSI scores and the post-treatment scores. The immediate psychosocial gains reported by Reddon et al. (2008) are evidently durable. The results of this study provide support for Life Skills as an effective treatment with persistent benefits for psychiatric outpatients. (Contains 4 tables.)
Abstractor: As Provided
Number of References: 22
Entry Date: 2009
Accession Number: EJ841689
Database: ERIC
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  Value: <anid>AN0033321109;88w01mar.08;2019Mar25.13:12;v2.2.500</anid> <title id="AN0033321109-1">Assessment of the Long-Term Benefits of Life Skills Programming on Psychosocial Adjustment. </title> <p>The durability of the psychosocial benefits of Life Skills programming on outpatient adults with mental health/forensic issues was examined. Participants were 52 adults (28 males, 24 females) who completed 16 weeks of Life Skills at a psychiatric outpatient clinic and were re-assessed between six months and six years following treatment. Psychosocial adjustment was assessed using the three scales of the Holden Psychological Screening Inventory (HPSI). Two groups of participants were compared, based on time since completion of treatment. There were no significant differences between time-based groups on the HPSI, but there was a significant gender effect for psychiatric symptoms, with females scoring higher on this scale than males (p =.028). When current HPSI scores were compared to HPSI scores that were assessed upon completion of Life Skills in a recent pre-post study on the same clientele (Reddon, Hoglin, & Woodman, 2008), analyses produced no statistically significant differences between follow-up HPSI scores and the post-treatment scores. The immediate psychosocial gains reported by Reddon et al. (2008) are evidently durable. The results of this study provide support for Life Skills as an effective treatment with persistent benefits for psychiatric outpatients.</p> <p>Keywords: Life skills; long-term benefits; treatment evaluation</p> <p>Since the 1970s, Life Skills programming has been employed in a variety of settings, ranging from elementary schools to psychiatric hospitals. Life Skills arose out of a multidisciplinary movement toward promoting effective psychosocial functioning, rather than focusing on ameliorating pathology. It indicated a shift from the medical model to a more optimistic model of psychological functioning, focusing on <emph>competence</emph> in a variety of daily living tasks (Gazda & Brooks, [<reflink idref="bib9" id="ref1">9</reflink>]; Wine & Smye, [<reflink idref="bib22" id="ref2">22</reflink>]). Life Skills programming was designed to help individuals develop "a repertoire of psychosocial coping skills that facilitate adaptation and performance in a variety of situations" (Larson, [<reflink idref="bib12" id="ref3">12</reflink>], p. 5). Specifically, life skills are identifiable "problem solving behaviors [that are] appropriately and responsibly used in the management of personal affairs" (Himsl, [<reflink idref="bib10" id="ref4">10</reflink>], p. 13). Some examples of life skills include goal setting, asking questions, and active listening skills. These skills are generally acquired via social learning during childhood and early adulthood, but individuals can fail to adequately develop life skills due to a variety of environmental, cognitive, or emotional factors (Himsl, [<reflink idref="bib10" id="ref5">10</reflink>]; Pratt & Mueser, [<reflink idref="bib15" id="ref6">15</reflink>]). A failure to develop critical psychosocial coping skills, which is common in individuals with mental illness, can have a devastating effect on self-esteem, emotional well-being, and vocational achievement. As a skills training program, Life Skills is designed to "improve the quality of life and well-being of the trainee" (Segrin & Givertz, [<reflink idref="bib20" id="ref7">20</reflink>], p. 137) by teaching adaptive problem-solving behaviors. Such training should enhance psychosocial functioning in clinical and non-clinical populations (Gazda & Brooks, [<reflink idref="bib9" id="ref8">9</reflink>]; Pratt & Mueser, [<reflink idref="bib15" id="ref9">15</reflink>]; Reddon, Hoglin, & Woodman, 2008; Reddon, Pope, Dorais, & Pullan, [<reflink idref="bib18" id="ref10">18</reflink>]; Segrin & Givertz, [<reflink idref="bib20" id="ref11">20</reflink>]).</p> <p>Life Skills addresses five main areas of human functioning: self, family, leisure, community, and job/education (Conger & Mullen, [<reflink idref="bib5" id="ref12">5</reflink>]; Himsl, [<reflink idref="bib10" id="ref13">10</reflink>]). The program at the Community Living Program (CLiP; an outpatient clinic affiliated with Alberta Hospital, Edmonton) specifically focuses on enhancing interpersonal and practical skills related to relationships, social roles, family interactions, sexuality, substance abuse, leisure activities, time management, and vocational success (Reddon et al., 2008). The course takes place on 5 half-days a week for 16 weeks. As a psycho-educational treatment, this intensive program incorporates cognitive-behavioral and interpersonal group therapy techniques to enhance participants' ability to cope with life situations in an effective, appropriate manner. Proponents of Life Skills and other social skills programs implicitly use the stress-vulnerability model of mental illness to provide a theoretical framework to their work with psychiatric clients (Pratt & Mueser, [<reflink idref="bib15" id="ref14">15</reflink>]). The stress-vulnerability model conceptualizes mental illness as a product of a biological susceptibility that manifests itself, or is exacerbated, in the presence of stress. Life Skills coaches teach students how to adaptively cope with stressful life events; this training decreases the severity of psychiatric symptoms and/or minimizes the likelihood of relapse by increasing the participant's level of psychosocial functioning (Ford & Urban, [<reflink idref="bib7" id="ref15">7</reflink>]; Gazda, [<reflink idref="bib8" id="ref16">8</reflink>]; May, Gazda, Powell, & Hauser, [<reflink idref="bib13" id="ref17">13</reflink>]; Pratt & Mueser, [<reflink idref="bib15" id="ref18">15</reflink>]; Segrin & Givertz, [<reflink idref="bib20" id="ref19">20</reflink>]).</p> <p>Social skills training has been described as the "single most important innovation for the psychological treatment of persons with serious mental illness" (Bedell, Hunter, & Corrigan, [<reflink idref="bib2" id="ref20">2</reflink>], p. 220). Empirical studies have consistently shown that social/life skills training programs are effective in improving targeted skills, enhancing social functioning, increasing patients' level of assertiveness, reducing the severity of psychiatric symptoms and the length of stay at a psychiatric hospital (Bedell et al., [<reflink idref="bib2" id="ref21">2</reflink>]; Benton & Schroeder, [<reflink idref="bib3" id="ref22">3</reflink>]; Dilk & Bond, [<reflink idref="bib6" id="ref23">6</reflink>]; May et al., [<reflink idref="bib13" id="ref24">13</reflink>]; Reddon et al., [<reflink idref="bib18" id="ref25">18</reflink>], 2008). In a rigorous meta-analysis of 68 studies regarding skill training effectiveness for individuals with severe mental illness, Dilk and Bond ([<reflink idref="bib6" id="ref26">6</reflink>]) concluded that behavioral skills training is effective for teaching interpersonal and assertiveness skills, either within a hospital setting or in the community. Unfortunately, very few skills training studies provide follow-up data addressing the stability of results over time (Benton & Schroeder, [<reflink idref="bib3" id="ref27">3</reflink>]; Dilk & Bond, [<reflink idref="bib6" id="ref28">6</reflink>]). The few studies that address this concern suggest that follow-up effects are as strong as the effects obtained immediately post-treatment. For example, Benton and Schroeder's ([<reflink idref="bib3" id="ref29">3</reflink>]) meta-analysis of 27 studies, four of which included follow-up data for behavioral measures of social skills, indicates that differences in psychosocial functioning between trained and untrained psychiatric clients increases over time. The weighted mean effect size for the four studies was.67 immediately post-treatment; this mean effect size increased to 1.13 at follow-up. Although the number of studies containing follow-up data were disappointingly low, Benton and Schroeder's ([<reflink idref="bib3" id="ref30">3</reflink>]) meta-analysis suggests that psychiatric clients retain their learning and continue to benefit from skills training programs after treatment.</p> <p>Reddon and his colleagues ([<reflink idref="bib18" id="ref31">18</reflink>], 2008) conducted two studies on psychosocial adjustment for psychiatric patients immediately following completion of a 16-week Life Skills program. Psychosocial adjustment was measured by the Holden Psychological Screening Inventory (HPSI), a brief self-report measure derived from the Basic Personality Inventory to measure three components of psychopathology: <emph>Psychiatric</emph> (e.g., psychotic processes), <emph>Social</emph> (e.g., deviant socialization), and <emph>Depression Symptomatology</emph> (Aguiar, Reddon, & McNeil, [<reflink idref="bib1" id="ref32">1</reflink>]; Holden, [<reflink idref="bib11" id="ref33">11</reflink>]; Reddon et al., [<reflink idref="bib18" id="ref34">18</reflink>]). Both studies conducted by Reddon et al. involved administering the HPSI pre- and post-treatment to psychiatric patients enrolled in a 16-week Life Skills course. Results from both studies indicated that psychiatric patients experienced statistically significant improvements on the HPSI following successful completion of Life Skills, particularly for Depression Symptomatology. Of additional interest are the recent findings of Reddon and his associates (2008), which revealed improvements in Depression Symptomatology in both men and women and Psychiatric Symptomatology for women only, using a large sample size of 198 patients.</p> <p>The current study utilized a non-randomized between-groups design to evaluate psychosocial adjustment in adult psychiatric outpatients between six months and six years since their successful completion of the Life Skills program. As a follow-up of the repeated measures (pre-post) study conducted by Reddon et al. (2008), the present study employed the same psychological screening measure, the HPSI. In addition to comparing the scores of participants based on time since treatment, their scores were compared to the post-treatment results of Reddon et al. (2008) in order to assess whether (and how) Life Skills influences psychological and social adjustment over time following graduation from the program.</p> <p>The main hypothesis was that patients who had graduated more recently would have lower scores on the three HPSI scales than those who completed the program earlier. This was based on the idea that past Life Skills graduates would have had more chances to practice life skills in their daily lives and thus reap the full therapeutic benefits of the course. With practice, they would possibly experience a greater likelihood of interpersonal success and thus gain confidence in their ability to cope with psychosocial stressors. It was also hypothesized that both recent and older Life Skills graduates would have a higher level of psychosocial functioning than a comparison group (i.e., the post-treatment scores reported in the previous Life Skills study at Alberta Hospital), especially on the Depression Symptomatology scale. Differences are expected on this scale due to previous findings that social skills training programs increase positive regard for self and others (Benton & Schroeder, [<reflink idref="bib3" id="ref35">3</reflink>]; Reddon et al., [<reflink idref="bib18" id="ref36">18</reflink>], 2008; Segrin & Givertz, [<reflink idref="bib20" id="ref37">20</reflink>]). It was predicted that depressive symptoms would continue to improve with time following graduation from Life Skills, perhaps as a result of graduates becoming more adept at using life skills to facilitate positive interactions with others. Based on the results of Reddon et al. (2008), women were expected to show greater improvement in psychiatric symptoms than men.</p> <p>A follow-up program evaluation questionnaire was used to evaluate the attitudes of Life Skills graduates toward specific components of the course curriculum, as well as their practice of life skills in their daily lives. It was predicted that individuals who completed Life Skills at an earlier time would rate a greater number of specific skills as more useful than recent graduates because they may have had more opportunities to employ a variety of skills in their daily lives. It was hypothesized that the usefulness of skills would also be influenced by gender, with female participants reporting that Life Skills had a greater impact in their daily lives than male participants.</p> <p>The primary contribution of this study was the evaluation of whether the psychosocial effects of Life Skills remain stable over time. There is a great deal of literature outlining the short-term benefits of the program, but follow-up studies on the efficacy of Life Skills as an educational program with therapeutic benefits are necessary to better understand the full impact of the program on individuals with mental illness.</p> <hd id="AN0033321109-2">METHOD</hd> <p></p> <hd id="AN0033321109-3">Participants</hd> <p>In total, 52 individuals participated in the follow-up research study of Life Skills. The participants, who voluntarily took part in the study, comprised 28 males and 24 females who had completed the Life Skills course between 1997 and 2003. Their participation in the present study occurred between six months and six years since treatment. All individuals were present or former adult psychiatric outpatients who had been diagnosed with a mental illness. Sixty percent of the participants indicated that they were currently receiving outpatient mental health services, although 79% reported current use of psychiatric medication. Participants' ages ranged from 20 to 65 years, with an average age of 37 years (<emph>SD</emph> = 11). Participants' year of graduation from Life Skills is presented in Table 1.</p> <p>Table 1: Year of Graduation from Life Skills for Men and Women</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Year</td><td>Men (<italic>n</italic> = 28)</td><td>Women (<italic>n</italic> = 24)</td><td>N</td><td>Percentage of Total</td></tr></thead><tbody><tr><td>Group 1</td><td /><td /><td /><td /></tr><tr><td> 1997</td><td>3</td><td>1</td><td>4</td><td char="." charoff="50">7.7</td></tr><tr><td> 1998</td><td>2</td><td>2</td><td>4</td><td char="." charoff="50">7.7</td></tr><tr><td> 1999</td><td>4</td><td>4</td><td>8</td><td char="." charoff="50">15.4</td></tr><tr><td> 2000</td><td>5</td><td>5</td><td>10</td><td char="." charoff="50">19.2</td></tr><tr><td> Sum</td><td>14</td><td>12</td><td>26</td><td char="." charoff="50">50.0</td></tr><tr><td>Group 2</td><td /><td /><td /><td /></tr><tr><td> 2001</td><td>5</td><td>3</td><td>8</td><td char="." charoff="50">15.4</td></tr><tr><td> 2002</td><td>5</td><td>4</td><td>9</td><td char="." charoff="50">17.3</td></tr><tr><td> 2003</td><td>4</td><td>5</td><td>9</td><td char="." charoff="50">17.3</td></tr><tr><td> Sum</td><td>14</td><td>12</td><td>26</td><td char="." charoff="50">50.0</td></tr></tbody></table> </ephtml> </p> <hd id="AN0033321109-4">Measures</hd> <p>The Holden Psychological Screening Inventory (HPSI) was employed to measure psychosocial functioning. It is a 36-item self-report measure that contains three sub-scales each consisting of 12 items. Respondents use a five-point scale for each item. The three sub-scales assess the separate components of psychopathology: <emph>Psychiatric</emph> (e.g., anxiety, psychotic processes, somatic complaints), <emph>Social</emph> (e.g., impulse control), and <emph>Depressive Symptomatology</emph> (e.g., self-depreciation). The total score, which indicates overall psychosocial adjustment, is based on the sum of the scores on each scale. Lower scores indicate better psychosocial adjustment. Previous studies in community and clinical samples have demonstrated the internal consistency of this measure, as well as its validity as a time efficient method of screening for psychopathology (Aguiar et al., [<reflink idref="bib1" id="ref38">1</reflink>]; Holden, [<reflink idref="bib11" id="ref39">11</reflink>]).</p> <p>A questionnaire entitled the Life Skills Follow-Up Survey was used to measure participants' perceptions of the Life Skills program. This self-report measure, which includes demographic items (e.g., job status, gender, age), was designed to measure the impact of the program on the graduates' daily lives, perceived usefulness of specific skills in daily life, present life circumstances related to psychosocial functioning, and possible areas of improvement to enhance the experiences of future Life Skills participants. Primarily designed for program evaluation, this questionnaire was developed by the researchers to address specific components of the curriculum offered. It was piloted on three recent Life Skills graduates to assess the clarity of the survey items. Minor revisions were made and both Life Skills graduates and coaches deemed the questionnaire satisfactory to assess their program's strengths and weaknesses.</p> <hd id="AN0033321109-5">Procedure</hd> <p>The Life Skills coaches provided the researchers with a list of past graduates from the Life Skills program at CLiP. In order to inform potential participants about the project in a non-intrusive manner, the investigators identified past Life Skills graduates who continue to participate in programs at CLiP by using the hospital's patient care information system. Client files contained information about the individual's status at the hospital (i.e., "open" or "closed" hospital file), as well as the name of his/her case worker (usually a therapist or social worker). The case workers of potential participants were contacted and informed of the project. They were asked to provide a letter of invitation to their clients (i.e., Life Skills graduates). Life Skills coaches contacted potential participants who had closed files at CLiP. The letter of invitation asked interested individuals to either contact the investigators directly or notify their case worker of their willingness to participate in the study. In the latter situation, case workers passed along their clients' phone number (with their permission) to the investigator. Once it was known who was interested in participating, the researchers phoned each potential participant to provide more details about the study, answer questions, and arrange a date and time to meet with them at CLiP to conduct the study. Other than the offer of refreshments at the session, no promises or inducements were offered for participation.</p> <p>Individual participants met with the primary investigator (RS) at CLiP at a prescheduled time. They were told of the general nature of the study and provided with an informed consent form. Participants were told that, by signing the informed consent form, they were indicating that they understood the general nature of the study, they were assured their responses would remain anonymous and confidential, and they were consenting to research use of the information that they provide. Once informed consent was obtained, participants were asked to complete the HPSI and Life Skills Follow-Up Survey at their own pace.</p> <p>Following completion of the questionnaire, participants received a verbal debriefing and were provided with information on how to contact the researcher or the Life Skills coaches if they had any questions or concerns at a later time.</p> <hd id="AN0033321109-6">Analysis</hd> <p>The present study measured the psychosocial adjustment, the perceived usefulness of specific life skills, and overall impact of the Life Skills course on individuals who had completed the program between 1997 and 2003. Two groups were distinguished, based on the year of graduation from Life Skills: (<reflink idref="bib1" id="ref40">1</reflink>) early graduates who graduated between 1997 and 2000, and (<reflink idref="bib2" id="ref41">2</reflink>) recent graduates who graduated between 2001 and 2003. Multivariate analysis of variance (MANOVA) was used to compare groups, based on time since treatment and gender, on the three HPSI scales. Using independent samples t-tests, the HPSI scores from the present study were compared to the post-treatment scores reported by Reddon et al. 2008, separately by gender. The survey responses regarding the perceived usefulness of specific life skills and overall impact of the Life Skills course were compared using analysis of variance (ANOVA).</p> <hd id="AN0033321109-7">RESULTS</hd> <p>Each group had 26 participants with 14 men and 12 women. However, response rates on specific items on the follow-up survey varied considerably. An alpha level of.05 was used for tests of significance, all of which were two-tailed.</p> <hd id="AN0033321109-8">HPSI Scores</hd> <p>Descriptive statistics for the HPSI scores of early and recent Life Skills graduates are presented in Table 2. There were no statistically significant differences between groups based on time since treatment, nor were any interaction effects present between gender and time since treatment. However, women (<emph>M</emph> = 16.83, <emph>SD</emph> = 6.10) reported significantly more psychiatric symptoms than men (<emph>M</emph> = 12.68, <emph>SD</emph> = 6.86), <emph>F</emph> (<reflink idref="bib1" id="ref42">1</reflink>,<reflink idref="bib50" id="ref43">50</reflink>) = 5.108, <emph>p</emph> = .028.</p> <p>Table 2: Follow-Up HPSI Scores for Adult Psychiatric Outpatients (n = 52), Analyzed by Gender and Time Since Treatment</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>1997–2000 Graduates</td><td>2001–2003 Graduates</td><td /><td /></tr><tr><td /><td>Men (<italic>n</italic> = 14)</td><td>Women (<italic>n</italic> = 12)</td><td>Men (<italic>n</italic> = 14)</td><td>Women (<italic>n</italic> = 12)</td><td>ANOVA (<italic>p</italic>-values)</td></tr><tr><td>HPSI</td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td>Group</td><td>Gender</td></tr></thead><tbody><tr><td>Psychiatric</td><td char="." charoff="50">12.86</td><td char="." charoff="50">7.21</td><td char="." charoff="50">15.75</td><td char="." charoff="50">6.21</td><td char="." charoff="50">12.50</td><td char="." charoff="50">6.76</td><td char="." charoff="50">17.92</td><td char="." charoff="50">6.05</td><td>.625</td><td>.028<xref ref-type="fn" rid="fn1" /></td></tr><tr><td>Social</td><td char="." charoff="50">10.57</td><td char="." charoff="50">5.08</td><td char="." charoff="50">8.00</td><td char="." charoff="50">3.10</td><td char="." charoff="50">8.57</td><td char="." charoff="50">4.03</td><td char="." charoff="50">8.25</td><td char="." charoff="50">4.43</td><td char="." charoff="50">.463</td><td char="." charoff="50">.228</td></tr><tr><td>Depression</td><td char="." charoff="50">17.36</td><td char="." charoff="50">7.67</td><td char="." charoff="50">22.33</td><td char="." charoff="50">10.07</td><td char="." charoff="50">19.21</td><td char="." charoff="50">7.49</td><td char="." charoff="50">22.08</td><td char="." charoff="50">9.10</td><td char="." charoff="50">.737</td><td char="." charoff="50">.106</td></tr><tr><td>Total</td><td char="." charoff="50">40.78</td><td char="." charoff="50">14.39</td><td char="." charoff="50">46.08</td><td char="." charoff="50">16.09</td><td char="." charoff="50">40.29</td><td char="." charoff="50">12.96</td><td char="." charoff="50">48.25</td><td char="." charoff="50">15.82</td><td char="." charoff="50">.840</td><td char="." charoff="50">.113</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>Because time since treatment did not produce significant differences, the results were pooled by time and compared to the post-treatment scores reported by Reddon et al. (2008). Descriptive statistics and two-tailed post- versus follow-up significance levels are presented in Table 3. There were no statistically significant differences between post-treatment and follow-up results for either gender. Consequently, the gains in psychosocial adjustment at the end of the 16-week program were maintained. There was neither further improvement nor deterioration at follow-up.</p> <p>Table 3: HPSI Post-Treatment and Follow-Up Results for a 16-Week Life Skills Program for 52 Psychiatric Outpatients</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>Post-Treatment Scores<xref ref-type="fn" rid="fn2" /></td><td>Follow-Up Scores</td><td /></tr><tr><td>HPSI</td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>p</italic>-Values</td></tr></thead><tbody><tr><td /><td>Men (<italic>n</italic> = 105)</td><td>Men (<italic>n</italic> = 28)</td><td /></tr><tr><td>Psychiatric</td><td char="." charoff="50">12.52</td><td char="." charoff="50">7.21</td><td char="." charoff="50">12.68</td><td char="." charoff="50">6.86</td><td>.905</td></tr><tr><td>Social</td><td char="." charoff="50">10.81</td><td char="." charoff="50">5.08</td><td char="." charoff="50">9.57</td><td char="." charoff="50">4.03</td><td>.190</td></tr><tr><td>Depression</td><td char="." charoff="50">20.20</td><td char="." charoff="50">7.67</td><td char="." charoff="50">18.29</td><td char="." charoff="50">7.49</td><td>.220</td></tr><tr><td>Total</td><td char="." charoff="50">43.53</td><td char="." charoff="50">14.39</td><td char="." charoff="50">40.54</td><td char="." charoff="50">13.44</td><td>.294</td></tr><tr><td /><td>Women (<italic>n</italic> = 101)</td><td>Women (<italic>n</italic> = 24)</td><td /></tr><tr><td>Psychiatric</td><td char="." charoff="50">14.87</td><td char="." charoff="50">6.15</td><td char="." charoff="50">16.83</td><td char="." charoff="50">6.10</td><td>.162</td></tr><tr><td>Social</td><td char="." charoff="50">9.30</td><td char="." charoff="50">4.19</td><td char="." charoff="50">8.13</td><td char="." charoff="50">3.75</td><td>.213</td></tr><tr><td>Depression</td><td char="." charoff="50">21.54</td><td char="." charoff="50">8.06</td><td char="." charoff="50">22.21</td><td char="." charoff="50">9.39</td><td>.724</td></tr><tr><td>Total</td><td char="." charoff="50">45.71</td><td char="." charoff="50">13.13</td><td char="." charoff="50">47.17</td><td char="." charoff="50">15.65</td><td>.638</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0033321109-9">Life Skills Follow-Up Survey Results</hd> <p>Almost all of the participants (92%) indicated that they practiced life skills in their daily lives. The responses on variables related to use of specific skills were grouped into 10 clusters: attending behaviors, feelings, fact-finding questions, identifying assumptions, feedback, problem-solving, anger management, goal-setting, balanced self-determination, and relationships. Univariate ANOVA procedures were carried out on each skill cluster, using gender and the length of time since treatment as between-participants factors. There were no statistically significant differences associated with time since treatment in the assessment of the usefulness of specific skill clusters, nor were there any statistically significant interaction effects between the two factors. However, the differences between earlier graduates (<emph>M</emph> = 15.80, <emph>SD</emph> = 5.25) and later graduates (<emph>M</emph> = 18.79, <emph>SD</emph> = 5.21) was not far from achieving statistical significance for anger management, <emph>F</emph> (<reflink idref="bib1" id="ref44">1</reflink>,<reflink idref="bib47" id="ref45">47</reflink>) = 3.669, <emph>p</emph> = .062. For gender, there was a statistically significant difference in the perceived usefulness of fact-finding skills, <emph>F</emph> (l,49) = 4.150, <emph>p</emph> < .050. Females (<emph>M</emph> = 3.67, <emph>SD</emph> = 1.13) rated the usefulness of these skills more highly than males (<emph>M</emph> = 3.04, <emph>SD</emph> = 1.06), <emph>F</emph> (<reflink idref="bib1" id="ref46">1</reflink>,<reflink idref="bib49" id="ref47">49</reflink>) = 4.150, <emph>p</emph> < .050. Gender differences in the usefulness ratings of life skills related to feelings also approached statistical significance, with women (<emph>M</emph> = 7.38, <emph>SD</emph> = 2.22) rating these skills higher than men (<emph>M</emph> = 6.15, <emph>SD</emph> = 2.13), <emph>F</emph> (<reflink idref="bib1" id="ref48">1</reflink>,<reflink idref="bib49" id="ref49">49</reflink>) = 3.994, <emph>p</emph> = .051.</p> <p>In terms of specific skills within each cluster, there were statistically significant differences between genders and groups based on graduation year on several skills. There were no interaction effects between gender and time-since-treatment group, thus the presented results do not include interaction <emph>p</emph>-values. Response rates varied between items. Descriptive statistics and significance levels for the specific skills that had statistically significant group differences are presented in Table 4.</p> <p>Table 4: Descriptive Statistics and Analysis of Variance Results for the Ratings of Life Skill Usefulness for Adult Psychiatric Outpatients, Analyzed by Gender and Time Since Treatment</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>1997–2000 Graduates</td><td>2001–2003 Graduates</td><td /><td /></tr><tr><td /><td>Men</td><td>Women</td><td>Men</td><td>Women</td><td>ANOVA (<italic>p</italic>-values)</td></tr><tr><td>Skill</td><td><italic>n</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>n</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>n</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>n</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td>Group</td><td>Gender</td></tr></thead><tbody><tr><td>Describing feelings</td><td>14</td><td char="." charoff="50">3.29</td><td char="." charoff="50">1.27</td><td>12</td><td char="." charoff="50">3.58</td><td char="." charoff="50">1.24</td><td>13</td><td char="." charoff="50">2.98</td><td char="." charoff="50">1.12</td><td>12</td><td char="." charoff="50">4.08</td><td char="." charoff="50">1.17</td><td>.834</td><td>.030<xref ref-type="fn" rid="fn3" /></td></tr><tr><td>Use of 5WH method</td><td>14</td><td char="." charoff="50">3.00</td><td char="." charoff="50">1.04</td><td>12</td><td char="." charoff="50">3.42</td><td char="." charoff="50">1.16</td><td>13</td><td char="." charoff="50">3.08</td><td char="." charoff="50">1.12</td><td>12</td><td char="." charoff="50">3.92</td><td char="." charoff="50">1.08</td><td>.354</td><td>.047<xref ref-type="fn" rid="fn3" /></td></tr><tr><td>Time out</td><td>14</td><td char="." charoff="50">3.00</td><td char="." charoff="50">.88</td><td>11</td><td char="." charoff="50">3.18</td><td char="." charoff="50">1.40</td><td>13</td><td char="." charoff="50">3.69</td><td char="." charoff="50">1.03</td><td>12</td><td char="." charoff="50">4.25</td><td char="." charoff="50">1.06</td><td>.007<xref ref-type="fn" rid="fn3" /></td><td>.238</td></tr><tr><td>Developing Friendships</td><td>14</td><td char="." charoff="50">2.93</td><td char="." charoff="50">1.21</td><td>10</td><td char="." charoff="50">2.30</td><td char="." charoff="50">1.25</td><td>13</td><td char="." charoff="50">3.38</td><td char="." charoff="50">1.12</td><td>12</td><td char="." charoff="50">4.25</td><td char="." charoff="50">1.22</td><td>.001<xref ref-type="fn" rid="fn3" /></td><td>.733</td></tr><tr><td>Clarifying relationships</td><td>14</td><td char="." charoff="50">2.86</td><td char="." charoff="50">1.10</td><td>10</td><td char="." charoff="50">2.90</td><td char="." charoff="50">1.10</td><td>13</td><td char="." charoff="50">3.15</td><td char="." charoff="50">1.21</td><td>12</td><td char="." charoff="50">4.00</td><td char="." charoff="50">1.13</td><td>.039<xref ref-type="fn" rid="fn3" /></td><td>.182</td></tr><tr><td>Ending relationships</td><td>14</td><td char="." charoff="50">3.00</td><td char="." charoff="50">1.24</td><td>10</td><td char="." charoff="50">2.30</td><td char="." charoff="50">1.34</td><td>13</td><td char="." charoff="50">3.15</td><td char="." charoff="50">1.34</td><td>12</td><td char="." charoff="50">3.75</td><td char="." charoff="50">3.74</td><td>.035<xref ref-type="fn" rid="fn3" /></td><td>.889</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>Over half of the respondents felt that Life Skills had been "very helpful" or "extremely helpful" to areas of their lives related to the self and family relationships, while the program was seen as less helpful to areas of life related to job/education, leisure, and community involvement. The vast majority of participants (88.2%) had a positive overall impression of the Life Skills course, with 90% of the respondents indicating that there had been an improvement in their overall life skills since graduation from the program. When asked to think back and rate their overall impression of Life Skills and their level of improvement in overall Life Skills, participants' responses produced no differences in the graduation time-based groups, but there were significant differences between males and females. On average, women (<emph>M</emph> = 5.61, <emph>SD</emph> = .66) reported a higher overall impression of Life Skills than men (<emph>M</emph> = 4.68, <emph>SD</emph> = 1.33), <emph>F</emph> (<reflink idref="bib1" id="ref50">1</reflink>,<reflink idref="bib49" id="ref51">49</reflink>) = 9.002, <emph>p</emph> < .010. Women (<emph>M</emph> = 1.00, <emph>SD</emph> = .00) were more likely than men (<emph>M</emph> = 1.18, <emph>SD</emph> = .39) to agree that there had been an improvement in their overall life skills since graduation, <emph>F</emph> (<reflink idref="bib1" id="ref52">1</reflink>,<reflink idref="bib48" id="ref53">48</reflink>) = 4.418, <emph>p</emph> < .050.</p> <p>When asked what was most useful about Life Skills, most participants answered that they were most impressed by their coaches' support, the frequent interaction with other students, and lessons revolving around feelings (recognition and expression), communication, and feedback. Respondents identified the videotaping of certain exercises, role-playing, and the poor attendance of other group members as problematic or less useful aspects of their Life Skills experience. On the whole, respondents regarded Life Skills as a very enjoyable, effective course that facilitated the development of social skills that allowed them to change their lives for the better. They were especially appreciative of their Life Skills coaches' dedication and support.</p> <hd id="AN0033321109-10">DISCUSSION</hd> <p>The results of the current study run contrary to the hypothesis that psychosocial adjustment would continue to increase over time, but they do indicate that the immediate psychosocial gains reported by Reddon et al. (2008) remain stable over time. There were no differences between early and recent graduates on the three scales of the HPSI, which measure Psychiatric, Social, and Depression Symptomatology. Additionally, a comparison of the follow-up HPSI scores to the immediately post-treatment HPSI scores reported by Reddon et al. (2008) revealed no statistically significant differences. This finding suggests that Life Skills produces beneficial psychosocial effects for psychiatric outpatients that remain stable long after individuals complete this treatment. The immediate improvements in depression symptoms for both genders, as well as decreases in psychiatric symptoms for women, did not diminish over time in individuals who were assessed between six months and six years since treatment. This is an especially positive finding when one compares durable effects of Life Skills with the temporary psychosocial effects of psychopharmacological treatments and short-term relaxation therapies (Reddon, Hoang, Sehgal, & Marjanovic, [<reflink idref="bib16" id="ref54">16</reflink>]). Wallace ([<reflink idref="bib21" id="ref55">21</reflink>]) suggested that clients are more likely to deteriorate and re-experience acute psychiatric symptoms if psychosocial rehabilitative programs are not continued for at least two years, but the results of the present study indicate that 16 weeks of Life Skills training positively affects long-term psychosocial adjustment. These findings coincide with the stable follow-up results of previous studies on social skills training for individuals with mental illness (Benton & Schroeder, [<reflink idref="bib3" id="ref56">3</reflink>]; Dilk & Bond, [<reflink idref="bib6" id="ref57">6</reflink>]).</p> <p>The finding that women reported significantly more psychiatric symptoms than men, regardless of time since treatment, echoes the results of the study by Reddon et al. (2008). This consistent gender effect may be related to the nature of the Psychiatric Symptomatology scale of the HPSI. This scale not only reflects psychotic processes, but also encompasses anxiety and somatic preoccupations. Anxiety and somatization disorders are far more common in women than men (Carson, Butcher, & Mineka, [<reflink idref="bib4" id="ref58">4</reflink>]). The higher prevalence rate of these disorders in women may have produced the gender effect that was found for the Psychiatric Symptomatology scale.</p> <p>The results of the Life Skills Follow-Up Survey indicate that recent graduates of the Life Skills program are more likely than earlier graduates to highly rate the usefulness of skills related to relationships and emotion regulation (through "time outs"). These findings run counter to the hypothesis that individuals who completed Life Skills at an earlier time would rate a greater number of skills as useful. These results suggest that recent graduates may have a fresher memory of the life skills they have acquired that leads them to automatically apply these skills to their daily lives and rate their usefulness accordingly. It may be useful for Life Skills coaches to emphasize relationships skills during future follow-up groups in order to refresh older graduates' memories of these skills.</p> <p>The finding that there are gender differences, in the perceived usefulness of skill clusters related to fact-finding and feelings, suggests that women who have completed Life Skills are more comfortable using these skills than men, who may prefer to display stoic self-reliance for socio-cultural reasons. It may be useful for Life Skills coaches to monitor men's receptivity toward developing these skills during the course and stress the importance of such skills in the context of each participant's life, regardless of gender. The survey results indicate that women are more likely than men to report a positive overall impression of Life Skills, as well as an improvement in their own life skills following completion of the course. It is possible that the group format and content of Life Skills may hold greater appeal to women than men due to the former group's reported ability to quickly engage in emotional and relational topics within a group therapy setting, which facilitates collaboration and commitment to the group (Ogrodniczuk, Piper, & Joyce, [<reflink idref="bib14" id="ref59">14</reflink>]).</p> <p>Participants' commentaries indicate that Life Skills is considered most useful due to its emphasis on interaction between group members and coaches, as well as its lessons regarding communication skills and feeling exploration. In accordance with the literature on skills training for psychiatric patients, Life Skills is perceived as most beneficial in the interpersonal realm, increasing individuals' social functioning in a variety of situations (Bedell et al., [<reflink idref="bib2" id="ref60">2</reflink>]; Benton & Schroeder, [<reflink idref="bib3" id="ref61">3</reflink>]; Dilk & Bond, [<reflink idref="bib6" id="ref62">6</reflink>]; May et al., [<reflink idref="bib13" id="ref63">13</reflink>]; Pratt & Mueser, [<reflink idref="bib15" id="ref64">15</reflink>]). Not surprisingly, many participants indicated that the poor attendance of other students, the videotaping of exercises, and discomfort with role-playing exercises were problematic aspects of their Life Skills experiences. These issues are common problems in the delivery of social skills training that may be attributable to symptoms of the individuals' illness and/or social anxiety (Pratt & Mueser, [<reflink idref="bib15" id="ref65">15</reflink>]).</p> <p>The Life Skills program has enjoyed popularity and empirical support as a psychosocial intervention and preventative strategy for individuals with mental illness. Numerous studies have shown that completion of a social skills training program, such as Life Skills, improves psychosocial adjustment immediately following treatment (e.g., Bedell et al., [<reflink idref="bib2" id="ref66">2</reflink>]; Reddon et al., 2008). Although prior studies have provided useful data on the short-term effects of Life Skills on psychiatric clients, there have been no follow-up projects on the long-term efficacy of this particular program. Serving as a follow-up of the pre-post study on Life Skills by Reddon et al. (2008), the current study provides preliminary empirical support for Life Skills as an effective treatment with durable psychosocial benefits for individuals with mental illness. The results support the continued use of Life Skills in the psychiatric setting, but further research is necessary to explore the behavioral and psychiatric implications of Life Skills on outpatients.</p> <p>A major limitation of the study is that the sample was self-selected; only the Life Skills graduates who wanted to share their Life Skills experiences with others volunteered to participate in the follow-up study. The responses may be biased due to the possibility that those who chose to participate had stronger feelings about the program than the average graduate. It is also important to remember that research volunteers are generally more sociable, educated, and motivated by external approval (Rosenthal & Rosnow, [<reflink idref="bib19" id="ref67">19</reflink>]). Such characteristics may have affected psychosocial adjustment scores on the HPSI, as well as the largely positive responses on the survey. These limitations affect the representativeness of the sample, as well as the generalizability of the results and conclusions to other psychiatric outpatients. However, the current study found positive psychosocial effects of Life Skills that are consistent with the literature on social skills training for individuals with mental illness, suggesting that they reflect real treatment effects.</p> <hd id="AN0033321109-11">Acknowledgments</hd> <p>The authors thank Diane McNeil and Janice Godbout, as well as the therapists at Alberta Hospital Edmonton and the Regional Mental Health Program, for their assistance in implementing the project. Dr. Sandra Ziolkowski is thanked for her support, much-appreciated guidance, and constructive feedback. Finally, the authors acknowledge the participants who volunteered their time to this study, without them this study would not have been possible. Portions of this paper were presented on June 9, 2005 at the 66th annual convention of the Canadian Psychological Association in Montreal, Quebec.</p> <ref id="AN0033321109-12"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref32" type="bt">1</bibl> <bibtext> Aguiar, S., Reddon, J. R., & McNeil, D. C. (2003). Stability of the Holden Psychological Screening Inventory (HPSI) in psychiatric inpatients. Social Work in Mental Health, 1, 35–52.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref20" type="bt">2</bibl> <bibtext> Bedell, J. R., Hunter, R. H., & Corrigan, P. W. (1997). Current approaches to assessment and treatment of persons with serious mental illness. Professional Psychology: Research and Practice, 28, 217–228.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref22" type="bt">3</bibl> <bibtext> Benton, M. 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REDDON; BRENDA HOGLIN and MARY-ANN WOODMAN</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib22" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib10" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib20" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib13" firstref="ref17"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref33"></nolink> <nolink nlid="nl9" bibid="bib50" firstref="ref43"></nolink> <nolink nlid="nl10" bibid="bib47" firstref="ref45"></nolink> <nolink nlid="nl11" bibid="bib49" firstref="ref47"></nolink> <nolink nlid="nl12" bibid="bib48" firstref="ref53"></nolink> <nolink nlid="nl13" bibid="bib16" firstref="ref54"></nolink> <nolink nlid="nl14" bibid="bib21" firstref="ref55"></nolink> <nolink nlid="nl15" bibid="bib14" firstref="ref59"></nolink> <nolink nlid="nl16" bibid="bib19" firstref="ref67"></nolink>
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  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2008
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Evaluative
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Adjustment+%28to+Environment%29%22">Adjustment (to Environment)</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Disorders%22">Mental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/10509670801940987
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1050-9674
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The durability of the psychosocial benefits of Life Skills programming on outpatient adults with mental health/forensic issues was examined. Participants were 52 adults (28 males, 24 females) who completed 16 weeks of Life Skills at a psychiatric outpatient clinic and were re-assessed between six months and six years following treatment. Psychosocial adjustment was assessed using the three scales of the Holden Psychological Screening Inventory (HPSI). Two groups of participants were compared, based on time since completion of treatment. There were no significant differences between time-based groups on the HPSI, but there was a significant gender effect for psychiatric symptoms, with females scoring higher on this scale than males (p = 0.028). When current HPSI scores were compared to HPSI scores that were assessed upon completion of Life Skills in a recent pre-post study on the same clientele (Reddon, Hoglin, & Woodman, 2008), analyses produced no statistically significant differences between follow-up HPSI scores and the post-treatment scores. The immediate psychosocial gains reported by Reddon et al. (2008) are evidently durable. The results of this study provide support for Life Skills as an effective treatment with persistent benefits for psychiatric outpatients. (Contains 4 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 22
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2009
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ841689
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ841689
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/10509670801940987
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 121
    Subjects:
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Training
        Type: general
      – SubjectFull: Adjustment (to Environment)
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Mental Disorders
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Comparative Analysis
        Type: general
    Titles:
      – TitleFull: Assessment of the Long-Term Benefits of Life Skills Programming on Psychosocial Adjustment
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Sharma, Ruby
      – PersonEntity:
          Name:
            NameFull: Reddon, John R.
      – PersonEntity:
          Name:
            NameFull: Hoglin, Brenda
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2008
          Identifiers:
            – Type: issn-print
              Value: 1050-9674
          Numbering:
            – Type: volume
              Value: 47
            – Type: issue
              Value: 1-2
          Titles:
            – TitleFull: Journal of Offender Rehabilitation
              Type: main
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