Community College as Therapeutic Activity

by Louis Lehmann, Ph.D.

"Going to college" has become part of the therapeutic activity program for patients at the East Moline State Mental Health Center. Since 1974 residents have been earning official general studies credit as students in adult basic education and in continuing education classes offered on the hospital grounds by Black Hawk college.

Therapeutic recreators are involved with the coordination of the classes, the activity program, and the use of recreation to help facilitate learning. With residents functioning as students rather than as patients, teachers and therapeutic recreators work together on helping students to acquire such basic skills as reading, speaking, writing, and mathematics; to raise self-confidence; to learn and practice appropriate social behaviors; and to explore ways in which leisure time may be used.

The Pilot Program

Initial explorations by the college's Community Services Adult Basic Education Coordinator and the center's Activity Therapy Director led to a ten week pilot program in summer, 1974. The two worked together in recruitment and screening of nine teachers and two teacher's aides who were oriented to the facility's setting, relevant rules, policies and procedures, and characteristics of the students. The teachers were responsible to the Activity Therapy Department for selection of students, relationships, practices, and evaluations. In educational matters, such as curriculum and instruction, and in general performance effectiveness, they were responsible to the college, which provided all teaching staff salaries and most of the educational equipment and supplies.

Eighteeen classes met for usually two hours a day, five days a week. Typically a class included from 10 to 15 students. Classes were provided for two geriatric, nine adult, one alcoholic, and two adolescent wards. Patients from six of the nine adult wards attended centralized classes focused on reading, writing, number concepts, communications, and social skills. When necessary to stimulate motivation, special interest areas were utilized. For example, automotive manuals were used to stimulate interest in reading among mechanically-inclined alcoholics. Written directions for skills such as sports, sewing, and typing helped stimulate adolescent's interest in learning communications. Enthusiastic responses by patients and staff resulted in a joint commitment to continue developing the program.

Program Development

Subsequent developments included program extension and modification, coordination of efforts with appropriate community resources, staff communications, and recognition of patient's accomplishments.

Classes were extended to four adult wards operating under an adaptive behavior token economy program. Individual educational counseling replaced classroom instruction for alcoholics. Additional adult continuing education classes such as Music Appreciation and Communication Skills were introduced under a college tuition waiver for students over age 55. As program modification progressed, more evening and weekend classes were scheduled to develop a more balanced variety of educational experiences throughout the week.

Coordination of the program with community resources was developed through educational counseling, referrals, and liaison. Upon referral from a therapeutic recreator in the Activity Therapy Department, a designated Black Hawk teacher would consult with persons entering or leaving the mental health center concerning available education opportunities. Linkages were established between the program and the sheltered care facilities in which some patients would be placed.

An additional liaison was developed for students in the main Black Hawk campus two-year program who were admitted as patients. A Black Hawk teacher working in the center's program was assigned to help these patients to continue their studies during hospitalization.

Communication between the college's teachers and the activity therapy staff included additional planning and evaluation conferences concerning treatment goals and methods as well as program procedures. Joint in-service staff education helped therapeutic recreators and teachers to learn

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from each other's perspectives and skills. Development of an orientation booklet helped new teachers to become integrated into the program.

Graduation ceremonies were eagerly anticipated and proudly participated in by patients. The emphasis was on appropriate recognition and encouragement by teachers and staff.

Role Relationships

Crucial to the success of the program were the capacities of therapeutic recreators and teachers to modify role behaviors. Therapeutic recreators had to coordinate classes with other activities. Some classes were integrated with other activities and teachers had to work together on programs such as home economics, outdoor recreation education, drama, gardening, audio-visual programs, music, holiday celebrations, and special entertainment events. Therapeutic recreators and teachers developed mutual respect for each other's concerns and skills. Teachers stimulated therapeutic recreators to become more aware of learning potentialities inherent in activities. Therapeutic recreators helped teachers to become more appreciative of the special characteristics of the residents and of the values of recreation for such students.

Therapeutic recreators found new opportunities for different relationships with residents as students in classroom situations. Their own roles were often modified as they functioned both as consultants and assistants to teachers.

The teacher's interpretation of the adult basic education learning experience was a critical element. Traditional ideas of classroom formations, student behaviors, and teaching syles had to be modifed. Teachers were holding classes in dining rooms, dormitories, day rooms, and activity rooms. With attendance completely voluntary, teachers had to rely on persuasion for initial enrollments and on a continuing variety of stimulating experiences to maintain students interest. Students would sometimes wander in and out of classrooms. They might stay for only a few minutes and then move on, perhaps to return again moments later. Such behaviors often reflected interactions of psychological and physical disturbances, medications, and sometimes little knowledge or concern with traditional expectations of classroom behaviors. Consequently teachers viewed each appearance, no matter how small, as an opportunity for learning. Patience, adaptability, and an abundance of reinforcement for minute accomplishments were absolute necessities.

Results

The program generally results in measurable improvement for over half the hospital's 400 bed population in such educational skill areas as mathematics, English, reading, and development of self concept. Of these, one out of every eight had been working toward completion of high school equivalency certificates and one out of every six has been referred to community programs such as other Black Hawk educational programs, a center for the developmentally disabled, a work evaluation center, and a therapeutic social club.

Seventy percent of all patients advancing to placement in community living facilities have participated in the program, improving considerably in the coping skills, the positive self concept, and the motivation necessary for successful placement. Two thirds of these are over age 55 and have especially benefited in the above areas, often resulting in renewed interests in their surrounding communities, stimulation of dormant or new communicative behavior, and better orientation to people, things, and times in their environments.

The program stimulated constructive motivation through skill improvement for over 80 patients on the four hospital wards requiring closest supervision. On these wards, adult education was often the structured group experience in which patients were most interested and most productive. The program helped equip more than 40 of these patients with educational skills for coping on wards where more responsibility is expected.

Reviews of individual patients' accomplishments and program evaluation by all clinical staff, by Black Hawk College staff, and by the Illinois Office of Education have all been most favorable. Such results suggest that cooperative efforts between mental health centers and community colleges can continue to help patients improve in skills needed to deal with their present and future environments.

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