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May 2023 | VISN 5 MIRECC Link

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Supporting Recovery for Veterans with Schizophrenia: Strategies for Increasing Social and Community Engagement

Research Publication:

Bennett, M. E., Kuykendall, L., Harvey, K., & Lucksted, A. (2023). Increasing community engagement: Skills used by adults with schizophrenia participating in a psychosocial intervention. Psychiatric Rehabilitation Journal, 46(1), 83-93.

Bennett, M.E., Brown, C.H., Fang, L.J., Blanchard, J.J. (2023). Increasing social and community participation in veterans living with schizophrenia: A treatment outcome study. Schizophrenia Research 252, 262-270.

Many people living with schizophrenia have trouble enjoying social activities and engaging in their communities. Some can find it hard to be around other people which can make participating in social activities difficult. While medications can be a very helpful tool to manage some aspects of schizophrenia, medications may not help people get more involved in social and community activities. Psychosocial interventions – “talk” therapies that help people learn and practice new skills - focus on helping people learn skills that support achieving their personal social and community goals. However, psychosocial interventions have not been found to be a “sure thing”, perhaps because they focus on teaching and may not pay enough attention to helping people apply these new skills in their lives. That is, they may lack a “push” to translate learning into practice. Dr. Melanie Bennett and her team examined the impact of a group intervention that included skills building and real-life application to improve social and community engagement for Veterans living with schizophrenia. The intervention, called Engaging in Community Roles and Experiences (EnCoRE), is a 12-week program of group meetings that helps participants identify activities that are important or interesting to them, supports their trying them out, and uses each meeting to hear how things went and discuss what could be improved. Participants develop Action Plans to document the steps they need to take and the skills they need to use to successfully complete a personal social or community activity. The results showed that participants reported better social functioning after completing EnCoRE and better motivation to do social activities three months later. When asked what they found useful about EnCoRE, Veterans said:

I liked…how she taught us to act in different situations when we go out, how to talk, how to compromise, how to handle the situation...I was kind of procrastinating and lazy. That’s all I had to do is get up off the couch and go, and just going there is not going to hurt me. Once I get there, I feel okay.
The role playing…was helpful because it was like a real-life situation… It was good practice...It helped you feel more confident dealing with different people and different situations.
I started to appreciate the fact that it [ref. EnCoRE] was getting me out to do stuff in the neighborhood and I don’t need to be as reclusive as I’ve been.
But now I am planning…like recreational things. I go to the movies, go skating, go play tennis, go bowling, stuff like that. I’ve been actually visiting more, I’ll say but I still, kind of like with my family and my close friends, you know, but I have been meeting other people in the process. So you know, I went out and shot pool, I met people then, so I met people like that and it was a good experience.
I did a few things that I don’t normally do. I went out to the community center and I interacted with other people while I was out...
I had a picnic…that was from one of the Action Plans. And we went out…me and my cousin…got some money, we put together, got some hot dogs, hamburgers, whatever and sodas and carried it out to the park and spread it on the – set the table up and stuff. And we ate and had barbecues and hamburgers on the grill and hotdogs…all my cousins. They came and we had a great time.
We did an action plan and we learned how to assess our recreational activities and make plans…I went to movies, I went to the library, I read books. I went to church. That was a good thing for me because [before] I wasn’t planning.

What Can Providers Do?

  • Further testing is needed before EnCoRE can be made available to Veterans. However, delivering interventions so that they target learning and application may be the most useful for Veterans pursuing their recovery. Help Veterans develop a plan and problem solve what could go wrong ahead of time. And the next time you see that person, ask them how it went. If it didn’t go well, what might have interfered and problem-solving those things. If it did go well, making sure the individual links that their use of a skill helped it turn out well so they will continue to use those skills.

What Can Veterans and their Families Do?

  • The hurdle for many people is using what you learn to support your recovery. For example, “if you develop the skill of talking to people in a group room, but you never actually talk to people, it’s like a muscle that doesn’t get used a lot.” The takeaway for Veterans is using skills that you’re learning in your lives can help you do the things you want to do.
  • Even the most loving families can give up trying to change things if their loved one has gotten into a pattern of not doing social things or not getting involved in community activities. What families could do is help their loved one take it slow and “dip a toe in.” Help your loved one start small: take a walk, make a phone call, or visit with someone for five minutes. Over time your loved one might get more and more comfortable and then build on those things, for example, having longer visits.
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