Use of environmental supports among patients with schizophrenia

Objective: Cognitive adaptation training is a psychosocial treatment that uses individually tailored environmental supports, such as signs, calendars, hygiene supplies, and pill containers, to cue and sequence adaptive behavior in the client's home environment. Generic environmental supports offer a less costly treatment that provides a predetermined package of helpful supports to clients at the time of their routine clinic visit. Previous studies have demonstrated the efficacy of cognitive adaptation training. The study reported here examined the extent to which environmental supports are used by clients. Methods: As part of an ongoing study, persons with schizophrenia were randomly assigned to one of three conditions: cognitive adaptation training, generic environmental supports, or assessment only. Rates of use of supports for the first three months of treatment were examined for the first 64 patients assigned to the first two groups. Results: Rates of overall use averaged approximately 80 percent for cognitive adaptation training and 44 percent for generic environmental supports. Specific categories of supports were also significantly more likely to be used by patients who were receiving cognitive adaptation training. More than 66 percent of patients in cognitive adaptation training were classified as high users of supports (used more than 75 percent of supports provided appropriately), compared with only 13 percent of those who were receiving generic environmental supports. Conclusions: Environmental supports have been found to improve functional behaviors for patients with schizophrenia. However, supports are not likely to be used unless they are customized for individual clients and set up in the home environment.