In my work as a community-based OT at Mainstay, the Resources for Human Development program headquartered in Philadelphia, I noticed that the low reading ability of some of our consumers impacted their independence in their day-to-day lives.

While completing OT assessments these consumers would state "learning to read" as an area to focus on during therapy sessions. Some of the reasons they wanted to read were to "get a job" (or a better job), to "feel better about myself," to "be able to follow recipes in cookbooks" and to "get my GED." It seemed essential to find a process that could be used to teach individuals how to read.

By consulting with a former elementary school principal, I found an assessment and reading/tutoring model that had been developed from four reading programs into a hybrid that used a strengths-based approach. The model uses paraprofessionals as tutors/coaches who work one-to-one with individuals under the supervision of a tutoring/coach. This provides support to staff who may not be comfortable with the role of reading instructor.

It is also important to have the supervision so that readers are finding success and not encountering unnecessary struggles.

The assessment and reading materials in this program are from the American Reading Company, which provides materials written at individual reading levels. They are age appropriate, colorful and have a variety of topics that keep adults interested in the books.

The literacy improvement project started as a pilot program last November, and all our participants have moved up at least one reading level since then. Some have moved up four levels. The consumers are learning to read and are excited about the program.

Individuals participating in Mainstay have a diagnosis of MH/IDD and are between the ages of 21 and 51 years.

The Mainstay consumers have one-to-one staffing 24/7, so coaches are built into the program. Otherwise they would have to be recruited. Training for supervisors and staff prepare these individuals in how to support learning.

Consumers take an assessment that accurately identifies their reading levels. Levels range from yellow (reading readiness) to silver (12^th grade). The coaches and pupils meet weekly for 60 to 90 minutes in small, informal reading groups ─ typically two readers and two coaches per room. They read out loud with their coaches, identify "success" words, and participate in individualized, level-specific activities that reinforce reading concepts.

Coaches engage readers by asking questions about what they have read, sharing additional background knowledge about what they are reading and stimulating cognitive processes with the individuals. Clients are able to sign out books and take them home to read during the week. We document progress by recording the number of books each participant reads and when individuals move up a level. Award ceremonies, held every eight to 10 weeks, help to keep the enthusiasm high.

An unexpected benefit of the reading program has been the relationships that have grown between staff and consumers and the behavioral improvement supervisors have seen.

One young man asked how long we will keep having reading group because he wants to be able to read as well as his housemate, who is reading six levels higher. We will keep the group going until all reach their fullest potential.

At some point replication of this model will occur for other programs in the RHD family so that we will build a community of readers.

Christine Silverman, OTR/L, spent two years developing the Mainstay Reading Program. In existence since 1970, Resources For Human Development Inc now sponsors more than 150 human service programs in 12 states. RHD provides residential services to individuals with mental illness, mental retardation, chemical addiction and those who are homeless, plus job training, assisted transportation and crisis intervention. For more information on this reading model contact Christine Silverman at ChristineS@RHD.org.

To learn more about OT in mental health read Walking with Others: How OT will make it in mental health from our May 11 print issue and visit our Mental Health Center.