The Schizophrenia Rehabilitation Program (SRP) provides state of the art rehabilitation and treatment services to individuals with schizophrenia.
 
These treatments use neuropsychological principles to help patients improve their cognitive abilities and motivation.
 
As these skills are developed, the patients are then helped to improve the quality of their lives by finding jobs or other meaningful and productive activity in their communities.


Background

In 1995, the Schizophrenia Rehabilitation Center was opened to provide top quality long term intensive neuropsychological and vocational rehabilitation for schizophrenia. Research conducted at The Institute of Living and by other investigators over the last several years indicated that the cognitive impairments associated with schizophrenia are partially responsible for the chronic disability faced by these patients. Their poor concentration and organization, memory deficits, and difficulty initiating and maintaining behaviors make holding down a job or relating to others very difficult. These cognitive deficits often remain even after treatment with anti-psychotic medications and continue to impair the individual’s ability to function effectively.

Research at the IOL (supported by Hartford Hospital and the Spencer T. and Ann W. Olin Foundation) and at other cognitive rehabilitation treatment and research centers indicate that some of these deficits may be reduced through cognitive rehabilitation techniques. These rehabilitation techniques require that patients repeat a series of drills to practice their concentration, attention, memory, and problem solving.
 
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Program Description

The Schizophrenia Rehabilitation Program provides highly specialized training for individuals with schizophrenia, schizoaffective disorder, and other related illnesses. The program provides patients with the opportunity for success in daily endeavors and gradually builds upon these successes to improve their adaptive functioning. The classes and individual instruction are designed to educate patients about their illness and develop the skills necessary to maintain productive and meaningful activity. The program offers three specialty tracts:
 
The Early Intervention Track provides training and treatment for individuals during the first few years of illness.
 
The Prolonged Illness Track provides training and treatment for individuals with persistent and pervasive disabilities.
 
The Residential Track provides training and treatment for individuals who require a long term or permanent supported living situation. Patients participate in the training program while living in a group home on the hospital grounds.
 
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Summary of Program

In addition to traditional treatment services, SRP patients participate in a variety of individual and group training programs that aim to improve cognition, motivation, and interpersonal and vocational functioning.
 
At the onset of treatment, our multi-disciplinary team of psychiatric clinical and rehabilitation professionals completes a comprehensive assessment of the patients' strengths and weaknesses. This evaluation includes diagnostic, neuropsychological , psychiatric, psychopharmacological, functional, and vocational  assessments. Some evaluations are completed in the settings where the patients actually function (e.g. home, work, etc.)  These evaluations provide a platform for the development of individual treatment plans. The patients’ families are encouraged to maintain an active and ongoing involvement in the treatment, through attendance at the Family Support Program and through family consultations with the program’s staff.
 
Initially, patients attend the program at least 3 days per week from 9:00 AM to 3:00 PM. During these days, the patients participate in a variety of rigorous rehabilitation exercises that promote increased motivation and concentration. When these abilities improve, vocational counselors work with patients to obtain and maintain jobs or education. The Schizophrenia Rehabilitation Program schedule illustrates the weekly training routine.
  • The rehabilitation day begins with the Breakfast Club (Team Group). This session ensures that each patient is oriented and focused on individualized, daily goals as each day begins. Discussions led by staff focus on these goals and how to apply new skills to achieve success in the day’s exercises.
  • Next, is the Motivation Group.  This training session is designed to promote motivation, teamwork, social skills, and initiative. The patients participate in physical exercises that require them to behave in a manner that fights against apathy and inactivity.
  • The Cognitive Rehabilitation Program follows this meeting. This program provides systematic exercises to improve concentration, memory and other cognitive skills.
  • In the afternoon, the patients have individual meetings with their therapists or Skills Training Therapy Groups
  • To finish this full day of programming, the patients meet together for the Relaxation and Compensatory Skills Group. In this therapy session, their accomplishments are reinforced and they learn compensatory strategies to apply their new skills to endeavors outside the program. 
  • In addition, many patients participate in the Vocational Program which includes vocational counseling, job placement, and job coaching.
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
9:00 AM Breakfast Club
(Team Group)
  Breakfast Club
(Team Group)
  Breakfast Club
(Team Group)
10:00 AM Motivation Group or Psychiatrist Meeting Next Step Team Group Motivation Group Next Step Team Group Motivation Group or Psychiatrist Meeting
11:00 AM Cognitive Rehabilitation or Skills Training Motivation Group Cognitive Rehabilitation or Skills Training Motivation Group Cognitive Rehabilitation or Skills Training
12:00 PM Lunch Lunch Lunch Lunch Lunch
1:00 PM Cognitive Rehabilitation or Skills/Vocational Training
 
Relaxation Group

or Individual or Vocational Counseling

or Cognitive Rehabilitation
Cognitive Rehabilitation or Skills Training
 
Relaxation Group

or Individual or Vocational Counseling

or Cognitive Rehabilitation
Cognitive Rehabilitation or Skills Training
 
2:00 PM Relaxation   Relaxation   Relaxation
4:00 PM Family Sessions     Family Sessions  
7:00 PM  

Family Support Group 
(1st and 3rd Tuesday of every month)

     

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Description of Residential Program

In addition to the ambulatory rehabilitation program and vocational training experiences, the IOL operates a residential facility. This facility provides long-term placement for a small number of individuals. Some patients may live there on a relatively permanent basis, while others may be able to move to more independent living situations after an extended stay. The residential program was developed to help the patients compensate for the cognitive and adaptive skills deficits associated with schizophrenia. The program is located in the Buckingham Residence, a 13-bed group home operating on The Institute of Living campus. This allows the SRP Residential Track patients to socialize with other residents in the Buckingham Program, while receiving extra services to meet their special needs.
 
This program provides a home for individuals who require a higher degree of structure and continuity to live outside an inpatient unit, either due to their more substantial cognitive deficits or long-term institutionalization. Initially, individuals in the residential program attend the rehabilitation activities described above. In addition to their attendance at the SRP day treatment services, the Residential Track patients participate in daily physical exercise, personal hygiene, diet and nutrition, and social and recreational activities at the group home. As patients progress, vocational experiences are developed.  The long-term goal is for the home or community-based vocational activities to replace the rehabilitation exercises, as the patients are more able to maintain productive efforts on their own.  The SRP rehabilitation activities and residential activities of the Buckingham Program are fully integrated to provide continuity for the patients.
 
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Current Research and Program Evaluation

In addition to providing intensive neuropsychological and vocational rehabilitation, the SRP maintains ongoing treatment outcome research to evaluate its programs. The rehabilitation techniques applied in the SRP are systematically evaluated to determine the most efficacious and efficient way to improve the individual's quality of life. Objective evaluations are used to guide program development and individual patients’ treatment plans. Patients may be asked to volunteer to complete interviews or take tests as part of the research.  Patient participation in research projects is on a voluntary basis and patients can receive treatment even if the do not wish to be involved in the research. For copies of published articles about cognitive deficits in schizophrenia and evaluations of the efficacy of these treatments, contact the program manager.
 
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References

Brenner, H., Roder, V., Hodel, B., Kienzle, N., Reed, D. and Liberman, R. (1994) Integrated Psychological Therapy for Schizophrenia Patients, Hogrefe & Huber Publishers, Toronto.
 
Kern, R.S., Green, M.F. and Satz, P. (1992) Neuropsychological Predictors of Skills Training for Chronic Psychiatric Patients, Psychiatry Research, 43, 223-230.
Kurtz, M.M., Seltzer, J.C., Shagan, D.S., Thime, W.R., Wexler, B.E. (2007) Computer-assisted Cognitive Remediation in Schizophrenia:  What is the Active Ingredient?  Schizophrenia Research 89, 251-260.
 
Miran, M.C. and Miran E.R. (Unpublished manuscript) Inside/Outside Program: Neuropsychological Therapeutic Treatment for Seriously and Persistently Mentally Ill, Rochester, NY.
 
Seltzer, J., Cassens, G. & Conrad, C. (1997) Neuropsychological Profiles in Schizophrenia: Paranoid Versus Undifferentiated Distinctions, Schizophrenia Research 23, 131-138.
 
Seltzer, J.C., Kurtz, M.M., Thime, W.R.  (2006) Schizophrenia Rehabilitation Program at the Institute of Living:  Combining Neurocognitive, Motivational, and Vocational Rehabilitation.  The Behavior Therapist, Feb. 2006, 30-35.
 
Seltzer, J., Cassens, G., Ciocca, C., and O’Sullivan, L. (1997) Neuropsychological Rehabilitation in the Treatment of Schizophrenia, Connecticut Medicine, 61(9), 597-608.
 
Spaulding, W. (1992) Design Prerequisites for Research on Cognitive Therapy for Schizophrenia, Schizophrenia Bulletin, 18(1), 39-42.
 
Spring, B. and Ravdin, L. (1992) Cognitive Remediation in Schizophrenia: Should We Attempt It? Schizophrenia Bulletin, 18(1), 15-20.
 
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