OCCUPATIONS FOR SCHIZOPHRENIA
On the Road to Room Maintenance
By Michele Niemcyk and Peter A. Smith, with Laurie Knis
As level-II students completing psychosocial fieldwork placements, we were sent to a specialized residence program (SRP) in Passaic, NJ, that 30 clients primarily diagnosed with schizophrenia according to the DSM-IV criteria, call "home."
Each client has his own bedroom, all the rooms being on the same floor in the same building. When we arrived, the general setups included a single bed, a small closet, one dresser drawer and a desk, each within a 60-square foot area.
Room maintenance is a difficult issue for most of these clients. They find it more difficult to function in a disorganized living environment, but due to limitations in the performance component of their cognitive functioning, they have trouble problem solving, staying attentive, and organizing.
Staff at the SRP felt this would be the best area for us to work on.
To set the tone for the upcoming project, we needed to find a way to slowly catch the attention of the clients, who often demonstrate slow thought processes and must have repetition and concrete direction in order to benefit from therapy.
Activities to direct their attention to their rooms were carried out in weekly occupational therapy groups--we painted doormats and sponge-painted clay flower pots, gave away game prizes that included room deodorizers and air fresheners.
Then, at a community meeting, we asked for two volunteers to participate with us in a "special room project." "C." and "D." wanted to do so.
In order to succeed with the project, we needed to find some way to assess the rooms, tap into the clients' personal interests to motivate them, and create a collaborative effort between ourselves and the clients. Since our time was limited to two months, we also wanted to find a way to implement continued room maintenance long after we were gone.
In our initial inspection of our two volunteer clients' rooms, we found broken blinds, dirty clothes thrown in a closet, clutter and dust, unchanged bed linens, cassette tapes strewn about, and odors from unremoved garbage. After consulting with case managers and other staff members, we were advised that the clients with whom we would be working have always required assistance with maintaining their rooms, which quickly become cluttered and disordered once again.
The initial phase of our intervention was discussion. We spoke with the two clients individually as to their personal preferences in the aesthetics and organization of their rooms. This not only empowered them, but also helped us to discover what their interests were. We needed to motivate them to do what they wanted to do, as well as what we felt would be beneficial for them.
Both clients independently decided that the installation of new blinds should be the first step to improve their environments. D. also requested a light shade to cover a bare bulb, and C. wanted a cassette tape organizer in which to store his tapes. So we planned a trip out into the community to a general purpose store for occupational therapy group that week. This would put the two clients in a position to choose the blinds and practice exchanging money. With other clients invited, the trip would also provide C. and D. with the opportunity to practice socialization skills.
On the trip, our two volunteers decided on the specific colors of their miniblinds and on the appropriate size of the cassette holder needed for C.'s tapes. The men identified which brand of blind they needed to fit the proper measurements for the windows. Interestingly, we noticed that other clients became intrigued with what these two were doing, and one asked, "Can I look for something to make my room better, too?"
Our next task was to assist the clients in putting up the new blinds and organizing the tapes into the 60-cassette tape holder. D. was excited to put up his new blinds, and after completing the job, he exclaimed, "Wow, this really makes my room look like a cool red color!''
C. gathered all of his tapes and the covers for them from all around his room and spent time matching each tape to its cover, finally placing them into the holder.
Following this, we were told of an interesting phenomenon. On a community trip to the same store with non-occupational therapy staff members, D. initiated a conversation with staff concerning some further things he had thought of to improve his room. He had expressed an interest in using a portion of his weekly funds towards purchasing the desired items.
It was uplifting to see a client interested in making improvements without prompting or encouragement. The therapy focus had been for the clients to gain some motivation to maintain new, uncluttered and personalized environments. However, D. had taken that one step further, generalizing what he learned.
But both clients needed to find a better way to organize and use the limited space in their rooms. We knew the plan should include ways to increase storage space for clothes and reduce the general clutter.
We created a large shelf to reduce the problem of clutter and leave more space for clothing.
The goal was to make it easy for these clients to store their clothes in a simple, organized manner. Large plastic bins labeled "pants" and "socks and underwear " were placed on the shelf. In addition, C. and D. sponge painted the walls in their rooms to match the new miniblinds.
One final concern remained. Clients with schizophrenia require frequent verbal prompts to perform even the simplest ADL tasks, such as taking medication and daily showers. We needed to create a simple system for the clients to assist in continued compliance with the new storage methods and in cleaning their rooms with minimum involvement from staff.
In order to accomplish this, we broke the tasks into daily and weekly duties, and then incorporated those tasks into the clients' love of music.
Clients at the SRP constantly use headphones to listen to music. (They have been known to argue over which radio station to keep on in the day room, due to varied tastes in music.)
Specifically, C. was always listening to rap music on his headphones, and D. liked rock and roll. So we tailored an audio cassette tape to each of their likings and on the tapes depicted all of the tasks they needed to do to keep their rooms clean. The cassettes contained a song on one side to be played on a daily basis, and one on the opposite side for weekly room chores.
The songs guide these clients through all of the necessary tasks.
An example from the rap song is, "Tuck in sheets, pull covers up, put clothes in bins, and empty garbage can!" A verse from the rock and roll tune includes:
"You want to make your bed each day, and throw your garbage away!"
Finally, in an in-service for SRP staff, we made suggestions on how to use continuous repetition, using written instructions and verbal prompting, to get clients to listen to their tapes.
In undertaking this project, we followed the occupational therapy acquisitional frame of reference, and with a little ingenuity, we were able to achieve our goals.
* About the authors: Michele Niemczyk, OTS, is an OT student from Columbia University in New York, where she is in the final year of an entry-level master's program. Peter A. Smith, OTS, from Kean College in Union, NJ, has completed coursework in his OT baccalaureate program. Laurie Knis, MA, OTR, is a senior occupational therapist at St. Mary's Hospital in Passaic, NJ, and was the students' supervisor for this mental health affiliation.