The attentional impairments associated with schizophrenia are well-documented and profound. Psychopharmacological and most psychosocial interventions have been shown to have limited effect in improving attentional capacity. That said, one form of psychosocial treatment, attention shaping procedures (ASP), has been repeatedly demonstrated to produce significant and meaningful change in various aspects of participant attentiveness behaviors. To date, studies of ASP have been limited in that they have been conducted primarily with inpatients, have not assessed the generalizability of ASP's effects, and have not explored whether reinforcement is required to be contingent on performance of attentive behaviors. To address these limitations we conducted the first randomized clinical trial of ASP with people diagnosed with schizophrenia who are being treated in a partial hospital program. Our results indicate that ASP is effective in improving attention in people with schizophrenia in these types of programs, the effects of ASP generalize outside of the immediate treatment context to both other treatment groups and real world functioning, and contingent reinforcement is a critical ingredient of ASP. This project provides further evidence for the benefits of use of ASP in the recovery-oriented treatment of people diagnosed with schizophrenia who have significant attentional impairments.

Staff members in psychiatric hospitals are frequently assaulted by patients. When asked what events triggered specific assaults on staff, staff and patients disagree. Staff members usually say that symptoms of psychosis led to the assault, whereas patients usually say aversive interactions with staff triggered the incident. For years, experts have called for direct observational research to address this issue and possibly resolve the discrepancy found in the verbal-report data. Over 26,000 hr of direct observational coding of staff activities, including staff-patient interactions, was collected across 10 years by independent, noninteractive raters on Social Learning Program units. Eight of nine kinds of aversive staff-patient interactions occurred more frequently among staff members who had been assaulted. One possible interpretation of these data is that aversive interactions lead to assaults on staff, but other possibilities must be considered. Practical recommendations for reducing likelihood of assault are detailed.

Deficits in adaptive behavior are a major reason why individuals remain hospitalized or return to inpatient settings. During recovery from a serious mental illness, development of adaptive behavior is as important as reduction of 'symptoms'. Social learning programs (SLPs) have been identified as a best practice in inpatient settings. This study examined whether SLPs facilitated significant growth in adaptive behavior from baseline through one, two, three, and four years of intervention. Direct observational coding of adaptive behavior was conducted before and during intervention and subjected to pre-post analysis. In addition, individual change modeling was used to characterize the rate and extent of change. Finally, initial response to intervention was examined for utility in predicting total response at distal time points. The SLPs facilitated significant improvements in total adaptive behavior from baseline to each of the distal time points (with effect sizes from 1.18 to 1.53). Change during the first five weeks failed to consistently predict total change, likely because of adaptive intervention procedures. SLPs facilitated significant improvements in the kind of adaptive behavior that helps people get out and stay out of inpatient settings. If replicated, estimated rates of change established in this study could be used as benchmarks for future implementations.

Better outcomes for psychiatric inpatients classified as paranoid rather than nonparanoid could be due to group differences in disability levels created by traditional classification approaches. Paranoid functioning, per se, may not predict good institutional outcomes. The authors retrieved community outcome data for 469 inpatients from 19 wards, a subsample of participants that had been previously examined during their inpatient stay. Paranoid groups showed better community outcomes as an artifact of differences in disability levels when classifications were based on the traditional approach that requires a predominance of paranoid over nonparanoid behavior. No differential outcomes appeared when classifications were based on dimensionally measured paranoid functioning alone. In fact, dispositions of patients suggest that staff view paranoid behavior as a negative rather than positive prognostic indicator.

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