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Li 1‘ I ’ ts This is to certify that the thesis entitled AN ARTS PROGRAM FOR THE SATISFACTORY USE OF FREE TIME FOR DEINSTITUTIONALIZED MENTAL PATIENTS RESIDING IN THE COMMUNITY presented by Suzanne Sheskin Ihilevich has been accepted towards fulfillment of the requirements for flyfl degree m 4mi/ fl/Z/ZM V Major professor Date z/é/fl 0-7639 MSU RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if Book is returned after the date stamped below. © 1979 SUZANNE SHESKI N I I'll LEV I CH ALLRIGlTS RESERVED AN ARTS PROGRAM FOR THE SATISFACTORY USE OF FREE TIME FOR DEINSTITUTIONALIZED MENTAL PATIENTS RESIDING IN THE COMMUNITY By Suzanne Sheskin Ihilevich A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Art Education 1979 ABSTRACT AN ARTS PROGRAM FOR THE SATISFACTORY USE OF FREE TIME FOR DEINSTITUTIONALIZED MENTAL PATIENTS RESIDING IN THE COMMUNITY By Suzanne Sheskin Ihilevich Recent studies indicate one of the greatest defecits of mental patients returning from institutions to their home communities is their lack of the personal and social resources with which to satisfactorily use their "free time." To compensate for this, an extensive recreational arts program is proposed. consisting of visual arts such as painting. sculpture. ceramics and printmaking, as well as poetry, music and drama. A pilot study is proposed, consisting of an experimental and two control groups, which will examine the potential usefulness of such a program. A new evaluation system developed by the Shiawassee County Community Mental Health Center will be utilized. It assesses changes in life style (Program Evaluation Scales), changes in specific problems and symptoms (Problem Area Checklist), and level of satisfaction with the program of both participants and their significant-others (Consumer Satisfaction Questionnaire). The results of this study should help determine whether an arts program such as the one described here. can significantly contribute towards the rehabilitation efforts made on behalf of deinstitutionalized mental patients. ACKNOWLEDGMENTS I wish to thank the members of my thesis committee, Professors Charles Steele, James Victoria, Mabel Namoto and Burton Merriam, for their help and encouragement in conceptualizing and planning this work. Thanks are also due to the Shiawassee County Mental Health Center for generously providing extensive information and material which was required for the preparation of this project. I am.especially grateful to my husband, David Ihilevich, for his continuous support and assistance. iii I. II. III. IV. TABLE OF CONTENTS PROBLEM MENTAL ILLNESS: AN HISTORICAL REVIEW RATIONALE FOR AN ARTS PROGRAM A. The Arts as a Humanizing Experience B. Psychosocial Effects: Process and Experience a. Acknowledgment b. Emotional Support 0. Reality Testing d. Value Clarification e. Sharing f. Humor g. New Vistas METHODOLOGY A. Procedures for Implimenting an Arts Program a. Selection of Subjects b. Resource People 0. Inservice Training B. Program Components a. Visual Arts 1. Rationale 2. Implimentation i. Drawing ii. Painting iv Page 25 25 29 30 31 32 33 33 35 36 36 36 38 38 40 40 40 #2 N6 47 Table of Contents continued.. iii. Sculpture and Pottery iv. Fiber Arts v. Printmaking vi. Photography b. Music 1. Rationale 2. Implimentation 1. Listening ii. Choral Group iii. Instrumental c. Drama 1. Rationale 2. Implimentation i. Drama Workshop ii. Play Reading Discussion Group d. Poetry 1. Rationale 2. Implimentation i. "What Does a Poem Mean?" ii. "HOw Does a Poem Mean?" iii. Poetry Writing Workshop Page 48 49 50 51 52 52 53 57 57 58 58 59 60 61 61 65 65 66 67 Table of Contents continued.. C. Program Evaluation a. Progress Evaluation Scales b. Problem Area Checklist c. Consumer Satisfaction Questionnaire D. Hypotheses Appendix A Samples of Evalution Material a. Progress Evaluation Scales b. Problem Area Checklist c. Consumer Satisfaction Questionnaire Appendix B Proposed Initial Outline for a Two-Day Inservice Training Program for Arts Resource People. REFERENCES vi Page 69 69 71 72 73 75 77 78 85 Figure Figure Figure Figure LIST OF FIGURES Cost for Institutionalizing One Person for a Full Year in 1978 in a Michigan State HOSpital. Status and Goals for Clients Resi- ding in Hart Pines Residential Faci- lity. Community Mental Health Ratings. Diagnosis of Resident Patients in State and County Mental HOSpitals in the United States: 1955 & 1973. Change in Population of State and County Mental Heepitals from 1900 to 1975. vii Page 12 14 Table Table Table Table LIST OF TABLES Page Mental Health Association Survey . 3 Level of Functioning for Dein- stitutionalized Clients (N=26), Rated by Shiawassee County Mental Health Center Psychotherapists on 7 Parameters of the Progress Evaluation Scales. 5 Admission Rates per 100,000 Popu- lation to Public or Private Psy- chiatric HOSpitals in the United States by Year, Marital Status and Sex. 18 Postdischarge Arrest Rates of Mental Patients With and Without Prior Arrest Records. 23 viii I. PROBLEM Mental Health professionals report that they have always found it difficult to cope with the issue of "use of free time" by deinstitutionalized mental patients. This problem is acute eSpecially when patients do not hold jobs or par- ticipate in day programs. However. it is also a problem for those who do participate in Day Treatment, Sheltered Work— shops and other rehabilitation programs. It has been ob- served that many of the difficulties these patients experience in their community occur in the evening, on weekends and on holidays, that is during their "free time." The problem is magnified by the fact that most deinstitutionalized mental patients lack the personal. economic and social resources necessary to function on their own in the community. The range of interests of these patients is usually narrow: most lack hobbies: the large majority do not read books, go out to places of public entertainment or participate in recreational activities organized by community groups. Since institution- alization besides being dehumanizing to the patient. is pro- hibitively expensive for society (see Figure 1. page 2), Special programs to help mental patients develop the per- sonal resources which will enable them to make more satisfac- tory use of their "free time" are urgently needed. A recently completed survey conducted under the auspices of the Mental Health Association in Michigan, has Fi re 1 Cost for Institutionalizing One Person for a Full Year in 1978 in a Michigan State HOSpital* $60,000 - $56,2l0 suo,ooo ' $20,000 - Mentally Ill Child Mentally lll Mentally Retarded Ad“ I t 963.50“ *From report issued by Michigan's Department of Mental Health. bearing on this issue. In this survey, the 5A Chairmen and 54 Directors of Community Mental Health Services in Michigan, the 26 Superintendents of Michigan's State institutions, the 11 members of the Legislative Committee on Mental Health of the State House of Representatives, the 72 Council Mem- bers of the Mental Health Association in Michigan. as well as the 6 Regional Mental Health Directors in the State. were asked if , in view of the fact-that 60% of admissions to State Institutions are made up of previously deinstitutiona- lized clients, whether. on the basis of their experience and knowledge of this population, an extensive recreation pro- gram for satisfactory use of free time by deinstitutionali- zed clients, deve10ped through contracting available com- munity resources, would make a difference in the rate of rehOSpitalization. The frequency distribution of responses recieved was as follows: Table 1 No. of Mental Health Association Survey respon- dents _¥§§¥ AL OTHER CMHZChairmenik #7 Council Members 85%» 6% 9% 4 Superintendents 75% -- 25% 2 Legislators 50% -- 50% 31 CMH.Directors 61% 23% 16% 5 Regional Directors 100% -- -- It is clear from this study that both front line workers, policy makers and the public-at-large concur with the need to do "something" about the issue of use of free time by deinstitutionalized patients. From the economic standpoint it has been established that the cost of out- patient programs is significantly lower when compared with the cost of inpatient services. It appears, therefore, to be fiscally advantageous to shore up outpatient programs in all possible ways in order to help patients adjust better in the community in which they live. A cost analysis of com- prehensive community services in 1978, with comparable ele- ments to services provided in institutions, indicates the following: Residential expenses for an individual in the community come to about $4,000.00 per year; Day Activity programs cost about $3,000.00 per individual: other services such as case-management, counseling and transportation costs come to another $3,000.00 per year. for a total of about $10,000.00 per year. Money, of course, has never been the only consideration for or against deciding whether patients should be institutionalized or deinstitutionalized. Safety, availability of local programs and community atti- tudes, have played a major role. Recently, however, the Courts have ruled that treatment must be rendered in the "least restrictive environment" in which patients can func- tion properly. Looking at the problem strictly from an economic standpoint, however, makes it clear that the cur- rent level of expenditure for deinstitutionalized patients living in the community is about one fifth of comparable institutional services. To enhance stabilization in deinstitutionalized clients in the community, pilot studies are urgently needed to guide the planning of additional services designed to help stablize deinstitutionalized patients and maintain them at the highest levels of functioning possible in the community. Extensive studies in Shiawassee County have indicated that the unsatisfactory use of "free time," _ the lack of prOper residential facilities, and the lack of suitable day activities, are the most important problems among deinstitutionalized clients trying to adjust to community life. As indicated in Table 2 below, and dis~ played in Figure 2 (page 6), 96% of deinstitutionalized clients cannot c0pe satisfactorily with their free time, ' with another 4% making only a marginal adjustment in this area of functioning. Compared to community norms, as shown in Figure 2, Use of Free Time is the area in which deinstitutionalized clients function the lowest. Table 2 Level of Functioning for Deinstitutionalized Clients(N=26) Rated by Shiawassee County Mental Health Center Psychothera- pists on the 7 Parameters of the Progress Evaluation Scales. Arggs of Fungtigging ve of tie * . 2 4 .5L Occupation (000) 62% 47% $96 15% 11% Getting Along (GOA) 0% 15% 27% 46% 12% Feelings a. Moods (ram; 0% 12% 31% 42% 15% Use of Free Time (UFT 38% 58% 4 0% 0% Problems (PROB) 0% 4% 46% 38% 12% Attitude to Self (ATS) 4% 8% 27% 31% 31% Family Interaction (RAM) 4% 50% 19%. 23% 14% * Level 1 is indicative of lowB'st functioning and 5 of highest functioning on the dimension rated. Figure 2 Status and Goals for Clients Residing in Hart Pines Residential Facility. Community Mental Health Ratings (N=26) ' 5 0 FAM OCC GAO FBrM UFT PROB ATS o l l l l l l l 4.6 4.2 3.8 3.4 3.0 2.6 2.2 flfl'""'Ea Normative Males (N-90) 1.8 -- H Normative Females (N-l'll) L4 "' w Current Status Hart Pines L @‘fi l2 Months Goals Hart Pines While the availability of treatment and rehabilitation services in the community is essential for serving deinsti- tutionalized clients (prOperly staffed Residential Facili- ties, Sheltered WorkshOps, Day Activity Programs, Case Management Services, etc.), for the proper integration of the discharged mentally ill in the community, much more than treatment and rehabilitation services are needed. These people need to feel involved in activities which bring both enjoyment and increased self~esteem. The idea that 93' hOSpitalized patients can be rehabilitated merely by being returned to the "community" and provided whatever local services are available, is a hepe that has not been ful- filled. It is now realized that mere "placement" in a home and "enrollment" in a Day Program does not accomplish "normalization" or "reintegration" into the community. The lack of attention to what happens during clients' "free time" is one example where continuity of care has broken down. The consequences of this are by and large still unknown, except for the 60% rehospitalization rate. This project will attempt to study the differen- tial effects of an arts program on the level of adjust- ment of deinstitutionalized clients in the community. The program is designed for implimentation after the clients have completed their participation in regular day programs such as gainful employment, sheltered workshops, day treatment or educational activities. In order to impliment any program with deinstitu- tionalized clients, it is first necessary to understand the historical background of community attitudes toward the mentally ill. The next section therefore, will describe the evolution of the still commonly shared attitudes towards the mentally ill in our society. II. MENTAL ILLNESS: A HISTORICAL REVIEW With the advent of secularism in Europe, in the 17th and 18th centuries, the view that disturbed behavior was a symptom of demonological possession, to be dealt with by exorcism or execution, began.to loosen its grip on society. In its place came the belief that deviance was a reflection of moral turpitude, best managed by disciplinary measures and segregation from society. While institutionalization replaced witch hunting, the basic objective continued to be the piotection of society, rather than the care for the individual. It was not until the ascendancy of "moral treatment," formostly advocated by Phillipe Pinel (Pinel, 1806) at the Bicetre HOSpital in Paris, early in the 19th century, that concern for the welfare of the institutiona- lized person began competing with concern for the protec- tion of society. As inhuman living conditions in institu- tions. coupled with harsh punishment, began to give way to a more humane approach, a growing interest developed in understanding the nature and causes of disturbed behavior from a scientific perSpective. Thus, society's attitude underwent a dramatic shift, gradually replacing the con- cept of social deviance with that of mental illness. While medical treatment became the new "rationale" fir’institutionalization, research confirms the existence of a strong residue deep in the public's mind, of earlier belief 10 systems (i.e., demonological possession, moral turpitude and/or social deviance), whicn continue to influence social attitudes, perceptions and practices towards the mentally ill (e.g., Nunnally, 1961; Lamy, 1966; Sarbin and Mancuso, 1970). In the United States, in the second half of the 19th century, there occurred a dramatic change in the care of the mentally ill as a result of a unique convergence of social, economic and medical developments. Public atten- tion was drawn to the plight of the mentally ill by the reform movements led by Dorothea Dix (Marshal, 1937). This coincided with the development of new concepts de- signed to explain mental illness as resulting from undesi- rable environmental conditions and/er organic deficiencies. The mentally ill, residing in squalid conditions in local jails and "homes," began to be transferred to small, local "institutions." It became rapidly apparent, however, that larger, state-run facilities would more economically meet the demands of the reform movement. By 1900, more than 100 such state institutions, designated as "asylums," were built in the country. In time, however, the large "cost-effective" mental institutions came to absorb a wide range of socially trouble- some individuals, who were labelled."mentally ill." As the proportion of chronic patients increased, the heapitals 11 became over-crowded and patient-care deteriorated. The prejudice, fear and rejection of the mentally ill, coupled with the lack of suitable local follow-up services, preclu- ded the return of many to their communities once they were hosPitalized. By early in this century, the network of state ' mental hOSpitals, once a proud tribute to an era of reform and humanism, had largely turned into a bureaucratic morass within which patients were interned, often neglected and sometimes abused. The "out of sight, out of mind"principle prevailed, to almost everyone's convenience (e.g. families of the mentally ill who couldn't cope with them at home; community neighborhoods who were concerned about safety and property values; state and local governments who found the arrangement cheap and convenient). Only scattered voices were heard in the defense of these neglected, warehoused people, whose number in 1950, in state and county hospitals, reached over half a million. Over half of the admitted patients were psychotic and schizo- phrenic, while another 20 to 25% were patients with neuro- logical complications (see FigurejB). The prognosis for cure, or significant improvement,for about 75% of admissions was, and still is, guarded at best. The reason for this pes- simism is the admittedly limited success of mental health professionals in treating psychotic and organic-brain-synd- rome disorders; at most their goals are maintenance and esopcchm coflpomem Marmara nmouomwa samnm.nmonomwa demeanowpmm Monro Hie beefing: .omoroamm nouwnom zfififiwuom owsmwno H9362 amazes mum. m a mam. mam. mam. mmm_ mam. mam mam. mam. mam. mam. mam. mam Mam. mam. ml... . a . 3W... W....w. . ..6..» _ . ll .. IV... . _ l . mm 3 N c we as am a... re au~ tel mw ~.~ . «o. o '. 7“— “P. ‘0 ‘ .. I ‘.-;:’a‘.'.:o!¢“\) 3.10.14 a... f . C 5' ' \‘I'f'. ‘ ‘ uc~ -I.OIP..’ -0 I a ".‘."v ‘ . . C’s f/ a . ' Q — I 73.1 . e . ( 1.. ~.s~ ‘ "”‘\:i .7',ror .C.‘ 1.1:; 2 (£5.93? , r Men A fin..‘.N‘ ' '.‘ unemfv s. i "6"! I no: '1‘: 9'. ~ Q '43” I 'c ". to 43“ .378; L15“ Ann, '.I' ‘L‘ e- ' | I o x '5 . m.~s a new nae .mama e “was .mopeem eeeaos esp CH manpfimmom HmPCmE hpcsoo new spasm CH mummwpmm pamowmom Mo mHmOSMMMD m o wwwm 13 and stabilization at relatively low and moderate levels of functioning. It was rejection of large numbers of young men from military service, on the ground of diagnosed psychiatric disturbance during World War II, that stunned the country and made the government and general public aware, for the first time, of the prevalence of various kinds and degrees of mental disorders and of the lack of attention that had been paid to this problem. This dramatic exposure, prob- ably more than any other single event, led to a new era of public concern which resulted in funding of research, new services and training programs for the treatment and pre- vention of mental disorders. In the early 1950's, there came a major medical deve- lOpment: the effective introduction of antipsychotic drugs. The result of this development was that thousands of patients, previously considered manageable only within the confines of an institution, could now be treated in out- patient clinics. That development led to the establish- ment of a network of community based treatment programs. However, before these programs were properly funded, staffed and adjusted to the clientele they were intended to serve, they were overwhelmed with institution-released clients. One result was that the number of patients in institutions decreased dramatically within a few years, as indicated in Figure 4. The population of mental hospitals has been reduced l4 Figgre 4 Change in Population of State and County Mental HOSpitals from 1900 to 1975 m i 600 4.. . w . . 3 .. .- . o :5: a \ 100 g . S 5 .uo O W 3 ‘W 1” 10:5 I.” 19.9 1960 I"! * From: Scientific American, February, 1978, Vol. 238, No.2 15 by two-thirds, from 559,000 in 1955 to 193,000 in 1975. This achievement, however, has been offset by huge increases in the rate of admissions to these hospitals (from 178,000 in 1955 to 375,000 in 1974). The shift in locale of service increases dramatically the total number of episodes (initi- ation of treatment), from 1.7 million episodes in 1955 to 6.4 million episodes in 1975. While in 1955 the state and county hosPitals served 49% of the episodes, in 1975 they served only 9%. Outpatient services, on the other hand, increased three-fold during that period: from 23% to 76% (from "The President's Commission on Mental Health, V01.II, 1978). In 1955, Congress established the Joint Commission on Mental Illness and Health to evaluate existing services and to formulate a national mental health program. The commission's recommendations, reported in 1960, provided the grqundwork for a landmark address to Congress by Presi- ’ dent Kennedy, which led in turn to the passage of the Mental Retardation Facilities and Community Mental Health Center Construction Act of 1963. The new concept of Community Mental Health implied the promise of treatment and rehabilitation of the mentally ill within the community, as well as early intervention and the promotion of sound mental health principles in the community at large. As massive deinstitutionalization was taking place, there was only vague anticipation of the strains this 16 process would place on communities, families, the released patients themselves, as well as the mental health profes- sionals staffing the newly founded Community Mental Health Centers. The conditions that developed in communities, where patients were frequently exploited, assaulted or neglected, led to the recognition that far more was in- volved than assuring that deinstitutionalized patients came to Community Mental Health Centers for "help" after they were released from institutions. For the professional staff to "stablilize" these clients' functioning in the community, a broad and expensive, and for all practical purposes, permanent set-up of follow-up services was neces- sary (Day Activity programs, Sheltered Workshops, Medica- tion Review clinics, etc.). In addition, properly super- vised residential facilities were required, since many of these patients had nowhere to go but squalid hotel rooms in run-down neighborhoods. As the cycle of exit from institutions continued and rehospitalization rates increased, it became apparent that in addition to a lack of suitable local services, many patients were either single and without a home, or had families who were unable or unwilling to cope with their erratic and at times frightening behavior. An analysis of the familial status of adults admitted to state institutions in the last decade in the United States is displayed in 17 Table 3 (page 18). It is clear from this data that married adults (who usually have a home to return to) constitute a minority of alllnspital admissions. The original expectation, that by keeping patients out of the hOSpital they would be kept in the "community," and that this tenure in the community would have a curative effect, proved naive by all accounts. This expectation, which is still widely held, is based on a rather vague notion of what constitutes a "community," how it functions, as well as on a misinformed view of a mentally ill patient's "life in the community." The concept of "community" has been defined by federal guidlines in terms of a geographical "catchment area," which may or may not bear any relation - ship to ethnic, religious, racial or cultural boundaries. In reality, many released mental patients, having no family wishing to accept them or no home of their own, have been frequently relocated into the poorer and more deteriorated areas where cheap boarding rooms were available and no organized community existed to protest the influx. Even in these areas, the former patients experienced rejection and discrimination, not only because of prevalent stereotypes associated with mental illness (i.e., unpredictability, moral turpitude, dangerousness), but also because of the negative social attributes they represented, such as poverty, 18 .mmaa .a.oz .nm.Ho> :.cwpoHH:m Hmowmoaozohmmg Boom e e.~ma H.men A.Hm m.oH~ a AaamH.eoeoeoamv o.mnn e.~aaH H.-a a.som 2 change mama H.nem o.aom m.oon o.e~n a Anama.aoeeeeamv n.6ae m.eomfi m.ea~ e.a~m a sausage «a-oama ~.ee~ o.mme\m.neos m.e~H H.~mN a - lemma.cow:eoe e soaeeomv o.m~o o.aoam\m.nam~ o.~mH. m.m e s oaaoso cams m.mmm m.-m e.mae m.mam a Aommfi.oosaev 6.6e0a o.~Ho~ m.moa 6.5ma : oaaoso some peace“; ooopo>wc ceased: cofioums xom Hmpwawon snow \ompmomamm no>mz no make museum Havana: exam one mapeom Havana: .oae» so moeaem eases: one as mawpflawom causewroamm mpm>mum no afifinsm op downwasaom ooo.ooH non woven cowmwfiscd awmamma 19 single status, elderly, dependent on public agencies, and the like. The more—well-to-do, organized communities dis- played their real attitudes toward deinstitutionalization by putting up barriers to patient residential facilities in the form of city ordinances and restrictive zoning regula- tions. They sanctioned police harrassment, job discrimi- nation and a broad series of more subtle exclusionary practices (e.g., minimal personal communication, failing to extend invitations to community activities, exclusion from social clubs, etc.). Another difficulty in reintegrating the deinsti- tutionalized client in the community stemmed from the fact that the staff of the Community Mental Health Center was prepared by training to work with mildly disturbed, out-patient clients who could benefit from insight or short-term therapy, and whose prognosis was reasonably good. Rarely had this staff recieved training with psycho- tics and/or brain-damaged patients, who constitute 75% of deinstitutionalized clients. The typical outpatient client, in contrast to deinstitutionalized patients, functioned in a job». belonged to a family, and was part of the community's social network, belonging to church, clubs, professional organizations, etc. The demographic variables of outpatients, for both men and women, varied considerably from those of deinstitutionalized patients. The latter 20 scored lower on personal, health and social adjustment indi- cators (such as employment and marital status), in practi- cally all the categories where comparisons were made. Deinstitutionalized patients, lacking family, integrating social networks and the habits and traditions of the "work ethic," were unable to fit into the available model of outpatient Community Mental Health services. Medications, which were supposed to function as adjuncts to treatment and rehabilitation services, in practice ended up substituting for them. Hardly any supportive services necessary to stabilize deinstitutionalized patients were developed (e.g. Sheltered Worksh0ps, Day Activity programs, Recreational activities, Case Management services and proper Residential facilities, supervised by trained staff). Living in the "community" became for'many deinstitutiona- lized patients a disabling, frightening, dehumanizing and isolating experience. Quite frequently, deinstitutional- ization turned out to be more harmful than the more re- stricting institution, where at least patients had a social support system, staff protection, recreational activities and basic care provisions. The result of the poorly planned deinstitutionalization was a massive return of clients to state facilities after only a brief and demora- lizing stay in communities. Those patients who did not 21 want to go back to institutions were forced to do so by their families, neighbors and the police via "commitment" provisions, which used the club of alleged imminent or potential "dangerousness." In Michigan, for example, about 60% of commitments to mental hospitals in 1978 were made under involuntary provisions initiated by police, family or relatives. DeSpite its extensive use, the concept of "dangerousness" has no scientific underpinning, according to most authorities. The American Psychiatric Association (APA, 1974), has formally adopted the position that at the present time there is no reliable and valid way to determine potential dangerousness. Social pressures dictate the reli- ance on the concept of dangerousness to achieve objectives extraneous to the issue of dangerousness per se. The evi- dence usually required to deprive a person of his freedom is not required when he is labelled as mentally ill. ’ A large number of investigators have found that the public holds two powerful stereotypes about the mentally ill: that they are dangerous and that they are unpredictable. It is these stereotypes that create community distance in relation to the mentally ill and erect barriers and dis- criminating practices against them (e.g. Nunnally and Kahn, 1960). The background of these attitudes is important to understand. The unknown has always aroused fear and anxiety. The stereotype of dangerousness attached to the mentally 22 ill (the unknown), served to "explain" and justify that fear. Unfortunately, that stereotype has been reinforced by the influx of large numbers of clients from the correc- tional system into the mental health system. The tendency to describe illegal behavior as sick behavior (thus im- proving our image of our fellow men), has done a great injustice to the mentally ill. Studies consistently indi- cate that mentally ill patients, without prior arrest re— cords, are not more dangerous than non-patients. While the prevalence of first arrests among the general public is about 4 to 5%,the average arrest rate among discharged mental patients is 1% to 4% (see Tablell, page 23). It is the patients with previous arrest records, who have usually been transferred from the correction to the mental health system, that perpetuate the myth of the dangerousness of the mentally ill. Actually, as a group, mental patients are more insecure, more withdrawn and less violent when compared to the general, "healthy," public. Sociologists believe that prejudices against the mentally ill serve as powerful defense mechanisms enabling the general public to hold, if not to practice, positive views of its own attributes. By projecting antisocial qualities on those who are different (i.e., mentally ill), the self-image of peaceful, loving, brotherly neighborhoods can be maintained in the face of extensive evidence of white 23 mama . fl .oz .om.Ho> ..:aeeaaem Haoamoaoaosma. sons e anemic made» mhmnad i an ems m as mass seasoned.caoeso menace means wuuoooo e a: saw as was mean soaamz.ceseeoem masses moans asuoooo e em elm as nan some .xoaaes.ceseeopm “saute ecoaoa> hoe Hams Aoamav .mua ompwouum omen; hacov op cosmmoun e xooousm --- eon m so 66mm .aomoeomm.caoeeu mono» moans Amwmav - m o mum Rdm m.“ mom hauqn .HmQNHNZ on HHH m memo» Academe no away mama Amsmfiv adv Rom N u 2 dam omwfi cosmonm e conoo mcsoooo monooou oownma mosooen sowed new: emomnomfic moosvsd nowua Prone“; uofina new; msuzoaaom masowpma mo .62 no name» oopmohpm cosmeonm ewwpcoouem owmpceouom emcnooom amoeba mowed prose“: one new: mwcmfipmm Hence: no nepmm vmosu< omumcomwopmom .m «Joe. 9 21, collar crime, daily newspaper, TV and radio reports of breaking and entering, drunken driving, car theft, rape, child abuse and other forms of domestic violence. It is indeed soothing to think that there are no criminals among- us, only "sick people" who can be identified by mental health professionals as "dangerous" and put away before they commit a crime. Unfortunately this tranquilizing effect generates more problems than it solves. It is now realized that there is no substitute for a realistic appraisal of our practices or for designing the best possible programs to help the mentally ill in their reha- bilitation and stabilization efforts in the community. The next section will describe a rationale for an arts program designed to help patients rejoin the community in which they live. 25 III. RATIONALE FOR AN ARTS PROGRAM A. The Arts As A Humanizing Egperience The effectiveness of commercial culture, which employs the tools of the arts (music, drama, visual imagery,zuwthm, rhyme, etc.) to sell soap and instant gratification, sug- gests that there are responsive chords waiting to be struck in all pe0ple by authentic aesthetic experience. Unlike commercial culture which tends to encourage passivity and gullability, authentic art should involve the whole person in an enlarging and enriching experience, which will engen- der feelings of enjoyment, accomplishment, self-awareness and growth, as well as a sense of belonging to the com- munity of men and women, rather than feelings of having wasted one's time . Participating in a form of artistic expression such as music, poetry, drama or painting, is likely to develop new interests, provide emotional enrich- ment and refine intuitive understanding. What is important to develOp today is the ability to "play," to enjoy the arts as part of one's life style and to have a sense of community with others of similar tastes and interests. While play and recreation are thera- peutic, they are not therapy in the traditional sense, that is, a context wherein past and present painful experiences are examined for the purpose of resolving conflict or modi- fying destructive attitudes and habits. The value of the 26 arts lies in the individual exploration of creative experi- ence, in the recapturing of a sense of individuality, in the heightened awareness of one's environment, and in a deeper appreciation of life. The usefulness afthe arts lies not in their possible (though questionable) value as diag- nostic tools or prescriptions for the working out of specific psychodynamic conflicts, but in their seminal importance as normal human activities which restore for people, a sense of appreciation of both the inner world as well as the world around them. People do not enjoy play because it is "easy,“ but because it presents a challenge to one's imagination or to certain skills one possesses. One must stretch oneself to meet the challenge and in the process possibly be changed by the experience (e.g., in chess as in football one seeks an opponent of roughly equivalent standing in order to set up a satisfying competitive game whose outcome is un- certain). Play creates a universe of its own, with structure, regulations and standards that are clearly separated and distinguished from the world of work. Play enriches the spirit and defines the individual in a different way than the world of work does, although professional artists, athletes and other players transcend this difference. They occupy a unique and recognizably symbolic place in our culture; they are the "stars,“ who embody our ideals and give reality to our fantasies and dreams. 27 In a society such as ours, in the face of increasing automation, people are finding it less and less possible to define themselves in terms of what they do at work. It is particularly important for those who cannot be in the work force to develOp the ability to become involved in activities which will give them a sense of contact with the world around them, and through this, a sense of self- definition, of self-esteem, and a feeling of belonging. Exposing individuals to a variety of art content areas, should ensure that they will be able to discover those modes of expression which are best suited to their temperament, their ways of‘dinking and feeling, and their style of living. Such involvement should provide an oppor- tunity to participants to grow and develop personally and socially in new directions, beyond those available to them through structured, work-oriented or purely therapeutic, problem solving programs. Exposure to the arts fosters an ability to empathize with meaningful cultural symbols such as myths, rituals, customs and traditions, all of which form the connections which allow us to feel that we belong to a culture, a people and a tradition. Such involvement is likely u>have a humanizing effect, not only because it involves the participant in uniquely human pursuits, which have engaged man since pre-history, but also in 28 that it enhances a sense of belonging to the community of men by~imparting a historical perSpective to the partici- pants. For example, sketching a tree or landscape and studying master drawings dealing with similar subject matter by great artists of various periods and styles, establishes a connection across time and culture. In a similar vein, reading a poem, no matter how sad, is an exhilerating experience for every person who finds that expression to be a true representation of their own feelings. Likewise, studying a play that explores the influence of vanity, ambition or jealousy in human affairs, illuminates the human condition in a manner that is both engaging and cathartic at the same time.‘ It matters not whether this encounter is with a contemporary poem or drama (i.e. Robert Frost's “Stopping By The Woods On A Snowy Evening," or Miller's "Death of a Salesman), or if it is one from a distant time or culture, such as Sophocles' "Oedipus Rex" or Japanese Haiku poetry. It is important to emphasize, at this point, that the arts frequently speak, as it were, in a different language which involves the senses with an immediacy that words rarely achieve. The feeling expressed and invoked by music, for example, cannot be translated into poetry, painting or any other medium. Nor, for that matter, can the feelings expressed through painting or poetry be effectively translated into another form. Indeed, it may 29 be said that each particular art form offers those able to reSpond to it a unique world of expanded feeling and imagi- nation. It is by intimate contact with various art forms that a person learns to experience and express thoughts, fantasies and feelings which are unique to that particular realm, be it poetry, music, scupture or drama. Through exposure and active participation, as audience and/or performer, new emotions are experienced, ideas, insights and imagination are expanded. Apart from the emotional and mental enrichment, ex- posure to a multi-faceted program of aesthetic activities should offer some of the more deprived and isolated members of our society an opportunity to participate in humanistic activities, to develop skills in aesthetic expression, as well as an ability to relate better to other people, both within their own residential community and in the community at large. How this is to be accomplished is described in the next section. B. Psychosocial Effects: Process gng Experience * It is important to conduct the arts program in foster .homes or Group Homes, where residents live and naturally % *Material for this section was obtained from personal communi- cations with Dr. Robert Patterson, Chief Psychiatrist,Shiawas- see County Mental Health Center: Ms. Lenore Kroman,Professor of Social Work, University of Michigan: and Dr. David Ihilevich, IDirector of the Shiawassee County Mental Health Center. 30 congregate. This locale has a number of advantages over attempting to enroll mental patients in existing community recreational programs before they are well prepared for such branching out. For one thing, community programs are usually operated at a higher level than that at which dein- stitutionalized patients can comfortably function. This is bound to inhibit their participation, increase their feel- ings of inadequacy and, most likely, lead to their with- drawal from these programs. On the other hand, operating a recreation program, which is especially tailored to the deinstitutionalized person, in a home where they live, that is, on their own "turf," is more likely to keep them at ease and sustain their participation. To implement an arts program with mental patients, much more is necessary than instruction. It is important that the following ele- ments be continuously emphasized in every aspect of each art program component. a. Acknowledgment As group members participate in discussions, express opinions, create art objects,etc., there is ample opportun- ity for the facilitator to set the tone and establish the pattern of interaction whereby the individual's views are summarized, discussed and clearly acknowledged by the group. This process of acknowledgment, to be beneficial, must be conducted in a supportive and dignified manner: it is impor- tant to assure by word and practice, that all contributions 31 are welcome and worthwhile to the group. The facilitator needs to continuously clarify what the matter under dis- cussion means to individuals in the group. The emphasis should always be on finding ways to enhance the individual's standing as a worthwhile person and as an accepted member of the group. Sarcastic, rejecting, cynical statements or gestures are to be avoided. If members resort to such behaviors from time to time, it is incumbant upon the faci- litator to request that they restate their remarks in non- offensive terms or, where suitable, provide an example of another way the point could have been made (e.g. suggesting to a group member that it would be more helpful to the dis- cussion if he said, "I am not sure what Mark's remark means," instead of "Mark is stupid and he doesn't know what he is talking about." Acknowledgment of individual contributions helps strengthen their sense of identity, uniqueness and worthwhileness as individuals and as group members. b. Emotional Spppprt To have one's views taken seriously by group mem- bers and the facilitator, irrespective of whether they agree with the views expressed, serves to build a sense of posi- tive self regard. Feelings of inferiority.and rejection and tendencies towards withdrawal from human interaction can be successfully counteracted by conducting the workshops 32 in a manner which places high priority on unconditional acceptance of opinions, safeguarding the dignity and self- esteem of participants and giving abundant emotional support for their efforts. The result of such support enhances the feeling of well being in the program participants. 0. Reality Testing The group needs to differentiate in its discussions between subjective opinions which are not contradicted by observable reality (e.g. "This music makes me feel happy”), and between responses which violate reality standards (i.e., since there is a general concensus that we call a particular musical instrument a "guitar," the group will not ad0pt a private termwused: by one of its members). The groups will continuously differentiate between "subjective," yet real experiences in the domain of feelings, wishes, taste and Opinions and the "realistic,“ which concerns socially accep- ted and agreed upon symbols, responses and behavior (e.g., one can have "real" feelings of fear of crossing a street, but these feelings are not "realistic" when one ascertains that no cars are coming from either direction before cros- sing). Since the arts program entails discussions of events in nature and in world affairs as well as the meaning of words and phrases, while continuously differentiating between the subjective, personal and intuitive on the one hand, and the "realistic" world on the other, a sharper 33 differentiation between the subjective world of fantasies and the real world of shared concepts and validated modes of proper behavior, is likely to improve judgment and real- ity testing among the group participants. After all, it is only because of group concensus that we call a certain fruit a'banana". d. Value Clarification In the process of examining poems, the positions of protagonists in plays, operatic plots and the like, a broad range of human yearnings would become the focus of attention for the group's consideration. The exploration of such con- cepts as "ambition," "loyalty," "greed," "friendship," "generousity," "vanity," and so forth, are all bound to clarify and deepen the understanding of the choices people have always had to face. It is the realization that one must make an active choice of the values one wishes to live by that contributes towards a deepened sense of self-aware- ness as well as a keener recognition of one's indentifica- tion with cherished values of society at large. Such an identification can both contribute towards one's own sense of belonging and worthwhileness, as well as towards the establishment of a clearer philosophy of life, one that is endowed with purpose, meaning and goals. e-éaarims Contributing to the group discussion, sharing one's opinions about a poem or a painting or a melody, is tantamount 34 to giving of one's own self to others. This process of sharing one's experience (i.e., thoughts, observations, feelings) leads to deeper trust, enhances both psycholo- gical intimacy and a feeling of belonging to the group. Thus a sense of "community," the only community this group realy lives in, becomes more meaningful. As long as sub- stantial reSpect is established and maintained within the group for individual differences, a sense of acceptance and feelings of belonging to the group will naturally follow. Such feelings towards one's group, particularly if they are shared and reciprocated, are well known to be among the most stabilizing social forces operating on an individual. LIME); Encouraging members to take the group experience in good Spirit, recognizing the role of laughter and humor as valuable contributions to the group's psychological climate, are important elements of this program. It is important to balance a somber outlook often encountered in poetry, drama and the visual arts, with humor, irony, paradox and wit which may frequently make life not only more endurable, but also more deeply experienced, deeply felt and ulti- mately more enjoyable. 35 g. New Vistas Broadening one's exposure to new areas of potential interest (e.g., tragedy and comedy, poetry and music, sculp- ture and painting), will add a unique humanizing dimension to the life of a participant in the program. The aesthetic sense evoked by the diversity and richness of the arts can be both immediately exhilerating and spiritually enriching long after the original experience has occured. 36 IV. METHODOLOGY A. Procedures for Implimenping an Arts Program a. Selection of Subjects Subjects in this study will be assigned to one of three groups, each group consisting of all clients residing in four homes selected at random from twelve homes that provide residential services to deinstitutionalized clients. Because of Michigan's new legislation authorizing the estab- lishment of homes housing 6 residents each, which cannot be restricted by local zoning ordinances, it is expected that residents of the four homes .willmake up about 24 subjects (for a total of about 96 subjects). The three groups will consist of an Experimental Group and two Control Groups. The proposed Arts Program womUlbe implimented with the Experimental Group: Control Group #1 would be exposed t0’ ongoing contacts with community volunteers with as similar a frequency as possible to that of the Experimental Group: Control Group #2 would continue during the life of the project (three years), as other deinstitutionalized clients living in the community. The selection of the nine homes to participate in the project will be carried out on the basis of the following criteria: 1. Over 75% of residents have been hospitalized at least once for a psychiatric reason, in either a state hospital, a federally operated facility or a private psychiatric hospital. 2. 3. 37 Subjects will be adults over the age of 18, with males and females about equally divided. They will be living in either supervised group homes, foster homes, or in independent group living ar- rangements. There will be no exclusion on the basis of race, religion, national origin or socio-economic status. To Optimize participation in the program and assure generalizability of results, the follow- ing categories of clients will be excluded from this pilot project: subjects diagnosed as sev- erely mentally retarded or senile, An effort will be made to include all other residents in the selected homes. Functional illiteracy, physical handicap, diag- nosis, enrollment in day programming, occupation, marital status and other demographic variables regularly collected by County Mental Health Agencies will be analysed for the purpose of describing the composition of the three groups, but will not be used as the basis for inclusion or exclusion from the project. 38 aw One of the central criteria for selecting resource people, in addition to mastery of the subject matter, should be the presence of enthusiasm about the subject they are to teach. It is vital that they radiate a joy for life, a sense of dynamism and vitality which is contagious. While these qualities are important in every teacher, in a pro- gram such as is proposed here, they are indispensable. In addition to being endowed with a zest for life, resource people should possess compassion and sensitivity, be willing to get involved in ongoing in-service training (geared towards the understanding of mental illness and the acquisition of constructive management techniques for handling disruptive behaviors such as withdrawal, ureason- able demands, anger and projection). In addition, the facilitators should be willing to make a commitment to stay with the project for at least one full year. Pre- ferably, they would be either teachers, practicing artists or graduate students, specializing in various arts and educational programs. c. In-service Training The in-service training should be conducted by a specially assigned liason person from Community Mental Health. Additional expertise could be drawn upon as needed, such as teachers who have had previous experience in working with mental patients. 39 An intensive workshop, extending over two days for all staff, prior to initiation of the program, should be planned. At this workshop, the program needs to be pre- sented in detail so that everybody understands both the individual art components as well as the overall design of the program. ESpecially prepared reading material for each area will be distributed, ways to initiate a program will be discussed, extensive "question and answer" periods after each presentation will be held. Since it is anticipated that many of the facilitators hired for the program will have only limited knowledge per- taining to mental illness, an extensive discussion of mental illness, its roots, causes,prognosis and especially its segregating effects on those afflicted, should be conducted. Special emphasis should be placed on the fact that most mentally ill have lost their self-confidence and sense of self-esteem. Most have no close friends and are only mini- mally involved in the community in which they live. More than anything else they need acceptance, friendship and understanding. 40 B. Program Components a. Visual Arts 1. Rgtionaleo An effective way of making an expressive experience available to adults of limited art background is to offer them the Opportunity to take part in the basic processes through which visual art forms are created. The satisfaction and delight inherent in making something with one's own hands, stems in part from the feeling of accomplishment gained through the acquisition of skill and competence. The hand- made object is a material witness to this accomplishment. These feelings are augmented by the exhileration felt when that object is one's own unique expression, embodying one's own feelings, ideas and personal perseverance. When the expressive element enters in, at however modest a level, we are talking about art. Practicing the skills involved in making visual art forms (e.g. painting, drawing, printmaking, sculpture, ceramics, weaving, photo- graphy) creates opportunities for, and encourages the deve- IOpment of artistic expression. Some degree of artistic expression is potentially available within every individual. In addition, while it may stimulate the development of these capacities, expression in the visual arts does not require verbal communication, social interaction or literacy as pre- requisites, but only a minimum of manual facility 41 and the exercise of the creative imagination. Through practice of visual "arts," one organizes the percieved world around oneself and begins to look at things more closely and observe them more clearly, as well as ex- perience them more sensually in terms of color, texture, line, form and rhythm. New relationships, similarities and subtle differences are absorbed and translated into an image which embodies vitality, Space, feeling and movement to some degree. Participating in this process of organi- zing elements from one's visual experience to create a visual image, on paper, canvas , or in clay, at however crude a level, should help one recognize and reSpond to this same process as it occurs in works of art. This res- ponsiveness can not only open up new and ever expanding worlds of aesthetic experience and satisfaction, it also can alter one's visual perception of reality. Who, for example, having seen Monet's "Waterlilies" or a stormy sky in a painting by Turner can ever see either of these pheno- mena in nature without refining back in their own minds to the painter's image of these things and thereby enriching their perception of reality? In more procsaic terms, this relationship between art and life is reflected in the phrase "As pretty as a picture," which is intended to indi- cate that the object elicits the heightened reaponse evoked by art rather than that which is evoked by reality. 42 2. Im limentation It is rarely enough to offer a group of artistically inexperienced peOple materials and techniques and encourage them to take off from there. Most peOple, particularly the withdrawn and lacking in self-confidence need to be exposed to "visually poetic ideas"(to paraphrase Kenneth Koch, 1970), which will serve to trigger their own visual imagination and set them off on experiments of their own. Group discussion and examples both from their peer level and from great art (which offers a diverse range of possible resolutions of the visual motif, be it portrait, landscape, geometric ab- straction or pottery form), are essential to give the novice some idea of the range of possibilities and inspire and ignite his or her own creative expression. One way to do this is through individual and group observation and discussion, both in terms of the process by which the work of art is constructed and in terms of the expressive illu- sion it projects and the feelings it elicits (e.g., a Sung dynasty porcelain may encourage contemplation and reflection on eternal values such as serenity, order and perfection: while an earlier Han dynasty vessel may radiate strength, confidence and vitality: the first being the result of highly refined craftsmanship, wherein each element is the outcome of careful consideration, whereas the latter reveals a more Spontaneous and direct approach on the part 43 of the potter: a 5th century B.C. Greek sculpture might reveal the impact of concern with ideal relationships in its sense of proportion, while an African sculpture might use distortion and exaggeration to express the power and mystery of natural forces. Visual ideas are garnered from a multitude of sources in nature and and in art, as well as from one's own inner feelings and imagination. Imitation and assimilation of other's art, particularly great art, into one's own work can be an advance on the road to more personal exploration and development. Every artist has taken whatever suited him from his predecessors and integrated it into his own mode of expression.' Perhaps with great artists the inte- gration becomes a new and more unique expressive form. Often the original source is diminished by comparison. Who cares, for example, that the story of " Romeo and Juliet" was in existence long before Shakespeare made it his own? Just as often we delight in detecting compositional or stylistic forms which have descended from teacher to pupil (i.e., from Titian, to Tintoretto, to El Greco) without in any way diminishing our perceptions of the unique achieve- ments of either, if not in fact enhancing it. While the process of assimilating and transforming the work of others may be less complete in people of more modest capabilities, the process itself may very well open up as yet untread avenues of feeling and learning. 44 The artist-facilitator may wish to augment his or her own demonstrations with presentations by other artists in the community or visits to their studios. If the artist— facilitator can share examples of his or her own work with the group, he or she will better serve as a role model for the group and foster the attitude that together they are engaged in a meaningful and creative activity which is purposeful absorbing and personally expressive. This attitude will be further reinforced if reproductions or slides of great art, from across a wide range of historical periods and different cultures, which relate to the parti- cular forms (i.e., landscape, portrait, abstract fiber wall hanging, vase or bowl) which group members are working with, are diaplayed and discussed by the group. Regular trips to libraries, particularly those with extensive collections of art books, to browse and borrow relevant material, should also be an integral part of each program unit. Every oppor- tunity to see and respond to original works of art should be taken advantage of. In addition to exhibits of local artists, excursions should be pushed to larger museums, galleries and art fairs. Of particular personal signifi- cance are visits to exhibits in which the work bears a relationship to something that one or more of the group members is doing, or is concerned with an artist with whom the group is familiar . When presenting reproductions of 45 great art for discussion, it might be wise to follow a version of the teaching principle which John Ciardi (1959) developed for poetry; Always presenting at least two com- parable works, direct attention to specific likenesses and differences so that one may be discussed and understood in terms of the other. The work of participants should be properly mounted and displayed. Some instruction in simple matting and framing is an essential part of the process of producing a two dimensional art form. Without this step the work can- not be viewed or valued prOperly. It may also be easily lost, damaged or forgotten. PrOper mounting gives the work dignity and acts to emphasize its separateness from the common reality: an object deserving of study and contem- plation which may reveal something as yet unexperienced to the viewer. A set of reversable display-frames might be acquired or constructed so that those who wished could exhibit their work on the residence walls. Similarly shelves should be constructed to display sculpture and pottery. An area should be set up in a communal area of the residence, and sheltered workshop facility, for the display of work done by group members. As the level of skill rises it may become more feasible to exhibit work in available community settings and at art fairs. 46 Exhibition is the way in which visual art is shared both within the group and with the community at large. The interaction which takes place between the artist, his work and his audience generates acknowledgement and a sense of self-worth which contributes to the group's pride in its accomplishment. i-Draairls Drawing from life is the prime source of visual arts ideas, be they two or three dimensional. Drawing trains the practitioner to look more closely and see more clearly, It trains the hand to put down what the eye sees, or what the eye wishes to see. Many people, unsophisticated in the arts, have an image of drawing which is limited to highly realistic rendering, the more precise and detailed, the better. Several instructors have suggested that as a first step this kind of drawing,with its accent on accurate recording of reality, should be taught. At the same time, master drawings from Altamira, through Rembrant, Matisse and Oldenberg, can be brought out to show how different and varied the guiding idea of a drawing can be. Whereas many of the distortions and exaggerations to be found in master drawings are to be regarded as deliberate or purposeful, the novice may be brought to feel the power of a spontaneous, swiftly laid down line, which while less exact may reveal movement and feeling more convincingly. Thus in his own #7 work he may discover that a strong "mistake" is more satis- fying and expressive than a patched up correction. He may begin to see how so-called "errors" or accidents can be used imaginitively to create expressive forms. This is not to say that meticulous and/or accurate drawing is not to be equally appreciated and encouraged if that is the inclina- tion of the participant. The artist-facilitator will want to introduce a variety of drawing media (i.e., pen and ink, charcoal, pencil, chalk, etc.) as well as approaches (i.e. naturalistic, impressionistic, abstract, expressionistic) and subject matter (i.e., portrait, landscape, still life, non-figurative). 11- Eelflilns Painting today is a generic term covering a variety of color media (pastel,watercolor, oils, acrylics, cut paper, etc.). There is a great area of overlap between drawing and painting, but by and large, painting deals with a surface quality resulting from the way color is applied, whereas drawing is primarily concerned with line. Nevertheless, there are paintings which are principally linear (i.e., Toulouse-Lautrec, Mondrian) and drawings in which the surface texture is highly developed ( Durer, Wyeth). For the purposes of introducing the art of painting in this project, the artist-facilitator should encourage the group to work directly with various painting media such as water color, oils, acrylics and collage. Based on the level 48 of interest and facility of the participants, choices should be offered which would allow working directly from nature, from imagination and from other resources such as photographs, slides or drawings. iii. Sculpture and Pottery The simplest and most versatile media for the intro- duction of the sculptural dimension into a program such as this is clay. Its plasticity and mallability lend itself to an infinite variety of treatments. Purely sculptural, as well as extremely functional work can be produced. The physical involvement one has with clay brings a unique sat- isfaction with it, as does the fact that one is actually creating "something" which is not an illusion of an image, as on the flat surface of paper or canvas, but a three dimensional object that occupies its own Space. It is perhaps for this reason that most of the art of pre-literate people is three rather than two-dimensional. They were creating objects invested with a high degree of emotional. religious and social significance and instinctively have chosen the most materially and physically realistic medium of expression. Similarly it has been noted that adolescents, who may be painfully self-conscious and inhibited when dealing with a two-dimensional medium, are freer and more inventive when modeling in clay. “9 The artist-facilitator will want to introduce various methods for building with clay: pinch, slab, and coil, as well as thrown pottery. The pleasure and sense of competence elicited from the successful throwing of a bowl or jar, amply justifies making a wheel available. The intricacies of glazing offer an added dimension which should not be neglected although it may have to be limited in a program of this nature. A kiln must also be made available. Modeled sculpture might be cast in plaster (waste mold). Other sculptural materials such as wood and metal may also be introduced at a later date. Jewelry fabrica- tion techniques such as sawing, filing, forging, sodering and pewter casting, might engage the interest of some participants in order 'to construct both pieces of jewelry and small metal sculpture. iv. Fiber Arts The fiber arts offer the uniquely satisfying tactile experience of the materials themselves as well as in com~ bination with color and texture and line, shape and pattern, in a relatively disciplined format. The endless varieties of possible results can be highly functional or purely aesthetic in value. They can take the form of a simple weaving on a stretcher bar frame or cardboard loom as well as an intricate batik or complex tapestry. As in most 50 visual arts, the prerequisite skills are minimal. they increase in complexity as the aspiration of the maker rises. v. Printmaking Printmaking can be embarked upon with or without a. press. Since a press is rarely available for a program such as this, it would probably be most useful to focus on the facinating things that a group can do without one. The media that can be employed in relief printing include card- board (i.e., cardboard shapes, cut out, inked, assembled in a design and printed) inner tube (i.e., shapes cut out of inner tube, glued to baseboard, inked and printed as in the above), and found objects (i.e., material such as leaves, shells bark, feathers, wire mesh, gears, keys, etc., inked and printed). These materials, because they can be quickly and easily assembled,allow the novice to experiment with the printing process itself from the beginning, without being detoured into carving a wood or linoleum block first (although these are rewarding in themselves and should be introduced at a later stage). They also lend themselves to creative experimentation, using design elements such as repetition, overlapping, color overprinting, mirror repeats, and the like, to form new shapes, colors and relationships. Simple silk screens are easily constructed and can be used to introduce the use of stencils in torn and cut 51 paper as well as tusche and glue resist stencils. By work- ing directly on the screen initially, the novice can acquire a feeling for the advantages and limitations of the medium which will help ‘him in more realistic planning, should he desire to make initial sketches before embarking on subsequent prints. vi. Photography Advances in photography have made it possible to acquire inexpensive cameras, enlargers, chemicals and paper to permit the implimentation of a black and white photography workshOp at a most reasonable cost. Further- more, with minimal training one can produce richly satis- fying pictures. The availability of community workshops, clubs and shows provide an excellent opportunity for transi- tion from group practice and personal development of skills, toward broader community involvement. Reviewing library books on photography and collections of great photography, could provide an added dimension to appreciation. Setting up a bulletin board in the residence where each participant is invited to place some of his work and share it with other members of the group, could be a most satisfying experience. 52 b- was 1. Rationale Even though various groups may be most responsive to different kinds of music, based on their cultural and ethnic background and the musicality of the particular individuals involved, it is commonly observed that most people find music of some kind or another evocative and pleasurable. While the reasons for this are not completely understood, it appears that a sense of satisfaction is experienced with great immediacy when one hears the kind of music one enjoys. A number of surveys have indicated that when people were asked to rank-order the ten most enjoyable experiences in their lives, music was usually ranked in the first or second place. Perhaps music has an impact on the senses equivalent to that of psychotropic drugs, in that both affect mood without first going through a process of conscious deli- beration. It is the circumvention of the rational dimension in our experience that explains the immediacy of our reaction to music . There appears to be a close emotional correSpondence between melody, rhythm, volume, tone and feeling. The interplay between these elements of music and our emotional reSponse to them is not consciously regulated. As a matter of fact, the temperament of one in- dividual or of an individual at a particular moment, may be such that he finds jazz most evocative and pleasurable, 53 while another individual may find Baroque music the most evocative and pleasurable. Some people reSpond most to vocal music, while others prefer the tone of a particular musical instrument such as the violin, flute or piano. Whatever the mode of expression, most individuals find some music that they feel deeply in tune with. The purpose of the music workshop would be to build on existing innate reSponses and predilections by both highlighting and expanding the repertoire of great music available to the group, which they may find appealing and enjoyable, as well as placing the music a participant en- joys already in a broader context, thus showing how it re- lates to other forms of musical expression. Thus, for example, many people who reSpond well to Jazz will find Vivaldi or Telemann as gratifying, once they are preperly introduced to them. In the process they will broaden and diversify their musical interests and expand their vistas and comprehension of this mode of artistic expression. 2. Implimentation A music recreation program could include several distinct units: listening to records, a choral group and an instrumental group, as well as a program of excursions to hear and see live concerts, Operas, and dance. 54 ' i. Listening The nature of the recordings employed would of course depend on the preferences of the participants, as well as on the interests and enthusiasms of the facilitator. As a matter of fact, any arts program, to be truly inspiring, requires an enthusiastic and charismatic facilitator who encourages participants to experiment with unfamiliar modes. The facilitator must have the rich musical background necessary to discuss the diverse responses of participants as well as to give them enough information about what they are hearing to enable them to listen in a new and more meaningful way. An added dimension would be given to this program by the addition of videotaped concerts, operas and ballets. Seeing and hearing a performed opera, for example offers a richer range of material fordiseussion (i.e., costume, acting, scenic effects, choreography). The ability to return and replay a particularly beautiful section would be an invaluable aid to learning and appreciation, it can reinforce perceptions vividly,as well as clarify dim recol- lections. Musical experience of this kind can be enjoyed by all members of the group no matter what their level of previous musical knowledge. 55 In contradistinction to the schools, where there is always the pressure of limited time and a large amount of material which needs to be covered in order to meet currie- ular demand,or time-limited workshops which concentrate intensively, but for a short time.on a particular play or novel. The approach suggested here more closely parallels the attitude advanced by the poet, John Ciardi. He dis- cusses the lasting advantages tO be gained from an in- depth familiarity with a poem. His analysis of "Stopping by the Woods on a Snowy Evening? (1966) illustrates that approach. Adapting that approach to the study of an Opera, for example, would entail first getting acquainted with a few of the most striking melodies in that opera, in order to evoke an interest and a strong bond to the work. Next one would familiarize the group with the outlines of the story as portrayed in the Opera. From here one could go back to the libretto Of the first melodies listened to, in order to discover what they mean, who wrote them, on whose story they were based, what prompted the composer to write music, how the characters are represented through the various melodies, and the history of some Of the great perfor- mances Of that Opera. Hearing on records, some Of the great singers who have performed these major songs and getting 56 acquainted with books, films and plays on the same theme, should allow the facilitator to slowly expand the repertoire to include other songs and melodies in that Opera. When the group is thoroughly familiar with the lib- retto, the individual melodies, and the dynamics of the composition, it is time to expose it to the whole Opera‘which may be a three to four hour ordeal on records, or videotape and, if possible,.in live performance. It is through such a gradual exposure that one's emotions, interests and en- thusiasm for the work of art is evoked and sustained. There is a risk in placing a group in the position of listening and watching a three to four hour opera without the invest- ment described above preceding it. Like many people going through such an experience, they may come out of it feeling bored, confused and numbed, and refuse ever again to sit through an Operatic performance. In this way a form of great art, one that can provide deep and lasting pleasure, can be lost from their lives forever. The same can be said about a Shakespearian play. Many people feel adverse toward Elizabethan drama because of superficial exposure, difficulty in following the dia- logue and a lack of opportunity available to develop an in-depth familiarity with one play and all its ramifications in terms of character portrayal. intuitive understanding, 57 tragic flaw and resolution. It is intended that this arts program will not have curriculum requirements to meet or a time frame for the study of a particular play, Opera, poem or symphony. The guiding principles should be the development of deeply felt pleasure and interest in the creative expre881ons of the human Spirit. ii. 99.2w A choral group, with or without a performance Objec- tive, can provide a community feeling and a pleasurable aesthetic experience. The songs selected can range from simple folk tunes to part-songs, melodies with descants and songs for solo and chorus, depending upon the capa- bilities of the participants. Once songs have been learned. group singing can provide Opportunities for those who other- wise have little to Offer, to creme a shared sense Of enjoyment in all the participants. iii. Instrumental Gregg An instrumental group could develop in a number Of different directions: a small improvisation group could be formed for thmmawilling to attempt individually created sound patterns; a band could be formed out Of instruments made by hand, Often from found objects; or the parti- cipants could learn to play simple instruments 58 such as the recorder or guitar. A tape recorder, for recor- ding and playing back the group's music.could Open up further possibilities for learning and sharing among the participants. mm 1. W The experience of drama as an art form, adapted for use with mental patients, has gone through extensive develop- ment in the past ten years, by the Imagination Workshop at Mount Sinai Hospital in New York City and New York Hospital, Cornell Medical Center. The facilitators used the same techniques they would use with any amateur actors. In their work with mentally ill patients of various diagnostic groups (e.g. schizOphrenic, manic, neurotic, depressed) , they strove to produce authentic dramatic portrayals Of vita- lity and relevance to the patients' lives. The drama exer- cises, improvisations and skits, while explicitly not therapy, appear to have had curative effects, according to a number of psychiatrists. The dramatic experience appear: to have helped patients emerge from isolation.and express re- pressed fears and fantasies, while using the legitimizing medium of drama. What is unique to drama is that it pro- vides an Opportunity to explore elements of character that patients may have repressed or have never developed,such as acting assertively, caring or being Openly angry. In 59 the non-threatening context of the drama workshop, where the expression of such emotions is standard fare, patients have an opportunity to securely experiment with new tones of voice, expression Of a wide range of emotion and changes in appear- ance by means of make-up, costumes and the like. While unequivocal proof of the value of a drama workshop for mental patients is unavailable thus far (mainly due to the fact that an evaluation system with proper experi- mental and control groups, has not been implimented as yet), it has been noted by a number of psychiatrists familiar with drama programs, that many noncommunicative patients who par- ticipated in the workshOps became more accessible to con- ventional psychotherapy, showing improvement in self—con- cept, a better relationship to their surroundings, improved personal appearance and more positive attitudes. As one patient put it,"It let me know that I can be in touch with people again....something I thought I had lost." (Quoted in the radio program "All Things Considered," NPR, July 2,1979). 2. Implimentation The drama program is envisaged with several kinds.of activities which can be used selectively. depending on the nature of the population one works with. i. Drama Workshop At the individual, participatory level. drama exercises. improvisations and skits, are used in the context of the drama 6O workshop. This entails asking the participants to play any- one but themselves (unlike psychodrama, in which patients play themselves and act out their own feelings and conflicts). If a participant in a drama workshop is asked to say or do something indicative of the feeling of "ANGER," and protests that he cannot do it, the workshop facilitator might en- courage him by saying, "It is not you I am asking to be angry, I want you to show me how the character you portray would express it." The function of the facilitator is to coax artistic expression from fledgling actors, not to function as therapist looking for hidden meanings and inter- preting behavior to patients. The workshop itself is neither explicitly labelled nor implicitly regarded as therapy. It is considered by staff and participants as a time for recreation, a time for taking part in a uniquely human activity, which gives the participant an Opportunity for experimenting with emotional expression and working with others in a non-threatening encounter. Such parti- cipation can give one a deep sense Of satisfaction and unique accomplishment. As one participant related after taking part in a play, "I feel very good about how I grew... and I wasn't doing it alone" (New York Times, June 19. 1979). ii. Play Reading Discussion Group In this format Of drama experience the group reads a play and analyzes its images, metaphors, style and 61 characterizations. Great plays, such as Shakespeare's "Macbeth" or Oscar Wilde's "The Importance of Being Earnest," provide ample Opportunities for an enriching analysis. The group can study a play in detail by reading and dis- cussing it for an hour or two each week. The readings may be accompanied by the viewing of the performances of prominent actors on videotaped sections of the play under discussion, or listening to great recorded performances. This approach is particularly useful as a preparation before going to see a live performance of an important play. Prior reading and discussion can assure undemmanding and invol- vement with what is happening on the stage. While some plays are easy to understand, so that a summary discussion of its content, motif, protagonists and a description of the role Of the more minor characters, would suffice as preparation for attendance at a performance (e.g. Arthur Miller's "The Crucible" or "Death of a Salesman"), for other plays, such as "Macbeth," or "Oedipus Rex, an in- depth reading could prove invaluable. d-BQEEL‘X 1. Rationale Studying poetry in a group context not only evokes a diversity of images, it also brings forth ideas that enrich each individual participant. Sharing Opinions with other 62 members in the group and having these Opinions listened to, acknowledged and discussed, enhances individuality and con- tributes to the participant's sense of self-worth and self- esteem. The sharing Of feelings and thoughts brings the group members closer to each other, thus building group cohesiveness, which is a precondition for tolerance and reSpect for individual differences. Soliciting, encouraging and supporting the expression of a diversity of views and emotional reactions, reinforces the legitimacy of individual differences in thoughts and feelings. Poetry reading is particularly conducive to that kind of experience because feelings can be discussed in terms of what the poem expresses or what the poet means, rather than as intimate personal revelations. Consequently, alienated, insecure and isolated. individuals may feel able to allow themselves to respond to the poetic image. Of all literary forms, poetry places the strongest emphasis on the expression of emotional experience. The focus in poetry is not so much in describing a situation or event as in one's reaction and relationship to that event or condition. In reading a good poem, where one gets at the essence of an experience (be it "unrequited love,"exhiler- ation," or "deepair"), one learns new ways of looking at human experience, both in terms Of its' potentially agonizing pain and ecstatic pleasures. 63 Of particular importance to people with a history of mental illness is the non-threatening atmosphere which en- ables them to share vulnerable aSpects of their personality. The presence of the facilitator should engender a sense of security in the participants. They should have the sense of assurance that the facilitator will protect them if they find themselves in difficulty, by serving both as a buffer and as a reconciliator among group members. The opportunity provided to each member of the group to Speak indirectly through the poet or the poem is an important safety valve that should not be underestimated. This medium enables the discussant to venture out and take risks, safely expressing views and emotions, with the knowledge that when he needs to, he may retreat "behind the poem" and more safely ex- plore its content and affect. Thus, the individual dis- cussant is able to set his own pace for self-expression, attributing as necessary, the feelings and thoughts expres- sed in a poem,to the poet, rather than to himself. The gradual sharing of feelings and thoughts with other group members increases empathy among them. The preoccupation with one's own feelings, thoughts and fantasies gives way to the recognition that others feel and think differently and that this is not necessarily wrong. One of the most exciting experiences for participants is the sense of "recognition" one acquires. Poets frequently express the very thoughts, feelings images and fantasies that their readers experience (but are unable to articulate with the same intensity and clarity). In recognizing their own feelings or thoughts in a poem, participants are able to become more themselves, since in so doing they have vicariously experienced and validated the legitimacy of their own emotions and ideas. The ability to put into words one's own feelings and thoughts, expressing such basic human emotions as anger, love, frustration or joy, leads to both better self-acceptance and better understan- ding of others. It enables peOple to re-examine their values, perceptions, needs and expectations and determine their assets and drawbacks. This should allow them to come to better terms with life as it is actually lived and experienced by them. Poetry should make a person more honest with him- self. The exploration of feelings and ideas should bring one into closer touch with one's own experience. The use of metaphoric language, symbol and rhyme, have the effect of powerfully registering their significance. Discussing the symbols, metaphors and allusions in a poem helps readers articulate their own imagery and emotions, while at the same time providing a socially sanctioned avenue for the expression of these private experiences. This expression is of vital importance for the integration into conscious 65 life of dim and fragmented sensations. The result is a richer inner life, better empathy and a more wholesome recognition of one's own needs, as well as the needs of others. In this reSpeet, the study of poetry is a humanizing process which enhances relationships and reSpect among people. 2. Implimentation There are a number of different approaches that could be used to impliment a poetry workshop. While this discus- sion will focus on three such approaches, others may be found which are as effective methods of teaching and experiencing poetry. Parenthetically, it should be said that these three approaches presented below do overlap to some degree and are in no way mutually exclusive. Nevertheless, each approach is sufficiently distinctive to give it an identity and character of its own. i. "What Doe§ A Poem Maggi" In this approach the group reads a poem, paraphrases its content or meaning, discusses their personal reactions to it, and then move on to another poem. In his book, "Familiar Poems Annotated" (1977), Isaac Asimov, the science writer, takes a pragmatic look at poetry. He makes no attempt to discuss the poem's structure or the deeper issues the poet may be concerned with; instead he restricts himself to explanations of background, history, and the meaning of words and phrases. He deals with questions 66 of fact rather than an examination of the poem as an organic whole. For example, in his analysis of Shelly's poem, "Ozymandias," he offers an extended discussion of the historical personage represented therein, as well as an account of the state of the art of Archeology at the time of the poem's writing. Unlike the other methods discussed, he does not treat it as a multidimensional,symbolic and ultimately intangible creation about time, power and vanity, which cannot be truly understood via a reduction to historical or vocabulary analysis, without losing its essen- tial insights. ii. "ng_Qoes A Poem Mean?" John Ciardi (Ciardi & Williams, 1978), on the other hand, stresses not what the poem means so much as how it says what it does. He feels that aesthetic excitement is bound to follow from Specific discussion of diction, meta- phor, rhythm, counter-rhythm and form, because these basic elements of poetry deal with exciting human ways of reacting to stimuli. Ciardi dismisses free association and analysis of words as dull and pointless. The words, images, rhythms, forms and dramatic situations in a poem are haloed by their own auras, conotations, suggestions and overtones, which are the basic source of poetic power. Ciardi prefers that we concentrate on how these forces operate within the poem rather than on private or extraneous associations. He feels that if one learns how these forces operate, one will 67 have identified the poem in action, experienced it as performance, and earn the same feeling of exhileration a fine actor has after having successfully performed a deman- ding role. His analysis Of Robert Frost's "Stepping by the Woods on a Snowy Evening" (1965) , serves as a, good example of his approach to the study of poetry. 111- W The practices of poet Kenneth Koch (Koch, 1970,1973). in his poetry writing and reading with school children, could easily be adapted to an adult pOpulation. Koch first developed his students' interest and enthusiams for writing poetry with a series of word games and collaborative poems. He actively discouraged rhyming, which he found inhibi- ting: instead he encouraged the develOpment Of poetic images and ideas which the group first jointly and later individually assembled as poems. Koch and others have found that poems written by peers were initially more in- timately meaningful and useful to the group than great poetry of which they stood in awe of and tended to regard as remote from their own experience and expression. He overcame this by first using peer poems as illustrations of "poetry ideas" the group would use to write their own poetry, and only subsequently introducing great poems to further illustrate the "poetry idea.“ Thus, for example, the group was asked to write a poem in which they asked 68 questions of a mysterious and/Or beautiful animal, and was offered examples done in the past by peers, as well as William Blake's "The Tyger" ("What immortal hand or eye/ Could frame thy fearful symmetry?") and "The Lamb" ("Little Lamb, who made thee?"). The students felt close to poetry because it was something they had created themselves. They had experience using poetic images based on comparisons, noises, colors, dream material, wishes, lies (exaggerations), and the like, which gave them an opportunity to create some- thing original, even in comparison with great poems. This method can, with some modifications, be adapted to the age, educational background and level of disturbance of the peOple one works with. To succeed in implimenting this method, it is important to be highly supportive of the participants' efforts. Furthermore, it is also necessary to size up the climate of the group and move flexibly back and forth between writing poetry and reading the poetry of poets. 69 C. Program Evaluation a. Progress Evaluation Scales The Progress Evaluation Scales (PBS) are made up of seven scales, each consisting of five levels, with Charac- teristics of each level described (Ihilevich & Gleser, 1979). The seven scales of the PES tap the areas of Family Inter- action. Occupation (school-job-homemaking), figlpipg_fllgng W_.__ith 0t_h_r_e 3. wt 8 d M . W: Emblems and Aptitugg Igwgpg §g1i (for a sample copy of the Adult Form,see Appendix A ). The scales can be used to indicate both current status functioning and goals and can be filled out by patient, therapist and significant-other. For data analysis purposes the five levels of each scale are assigned the numerical value Of 1 to 5, from the most pathological to the healthiest levels of functioning Observed in the community. Results of extensive studies over an eight-year period indicate that the PES is a sensitive measuring devise for assessment of current status and change over time in personal, social and community adjustment. 'The chief attri- butes of the scales are as follows: (1) Interviewers experienced in using the form can complete the scales in one to two minutes following a routine diagnostic interview. This factor is Of consider- able importance for using the scales on a continuous basis 70 and for maintaining high quality of data gathered. (2) The one page format, the clear language of the scales and the simple procedures of administration make it possible for most mental health clients and their significant-others to fill out the scales within five to' eight minutes. (3) Comparisons of clients' ratings to those of their therapists and significant-others, as well as com- parisons of ratings over time, yield important on-going information on the feelings, attitudes and expectations of the principal people who affect the outcome of the services rendered. (4) Reliability of PBS ratings was examined from thesmsmdpoint of generalizability theory, both in terms of inter-rater agreement as well as stability over time. The results indicated that 95% of the time therapists' ratings lie within 1.1 units from that obtainable were a large number of therapists to make every rating. and within 1.4 units from that obtainable were a large number of therapists to make the rating on the same individual on different occasions over a two week interval. A difference of ratings of two points between the ratings of two clients on any one scale represents a real difference at the 95% level Of con- fidence. Since the resolving power of the scale is one unit, the authors interpret these results as supportive of 71 the reliability of the PES scales. (5) Construct validity studies reveal that the scales (a) differentiate between normal and patient groups; (b) differentiate among groups of various degrees of psycho- pathology; (c) are by-and-large independent of demographic variables; (d) relate, in the expected direction to psycho- logical constructs measured by other established inven- tories: (e) meet criteria for convergent and discriminant validity on the basis of correlations between independent ratings of client or significant-other and therapist; (f) measure different domains of behavior and experience as in dicated by the low intercorrelations among them: and (g) are sensitive to changes in level of personal, social and com- munity adjustment as indicated by the independent ratings of the therapists, patients and significant-others at the beginning, re-evaluation and termination of therapy. The application of this evaluation instrument to the present program should enable one to explore in a substantive fashion, changes in life-style of patients who have been extensively exposed to an arts program as contrasted to patients who recieve only traditional mental health services. The PES would be administered every 6 months, in accor- dance with the instructions in the manual. b. The Problem Area Checklist (PACL) The Problem Area Checklist (PACL) consists of thirteen 72 (13) problem areas, with one section reserved for "other," where each problem is rated as flppg, Mild, Mgggggpg or §§g§§g, For each problem area, four subproblems can be recorded (e.g., for the Psychosomatic problem area, one can record "headaches," "ulcer," "asthma" and "hypertension). It has been found that the PACL can encompass in its current format 99% of the prob- lemsand symptoms presented by mental health clients (a copy of the PACL can be found in Appendix A ). Using this instrument can aid both in a descriptive sense, i.e., indicating the clinical nature of the popula- tion one works with, as well as in an evaluation sense, i.es gauging changes in severity and in kind of problem that have occurred from initiation to completion of the program. The PACL will be filled out by therapists on a six month basis, at the time they fill out the PES. e. Consumer Satisfaction Questionnaire (CSQ) The CSQ will be filled out at the end of each program year by clients or guardians and home Operators. A copy of a specially devised CSQ for this study can be found in Appendix A. 73 D. Hypotheses While it is recommended that this program be implimented as an exploratory study, designed both to refine the methodology and discover the optimal fit among various patient groups and particular arts programs, ascertain actual costs and the like, it is nevertheless desirable to examine the following preliminary hypotheses: 1. The vgcapulgpy of the Experimental Group will improve relative to that of the two Control Groups, as measured by the verbal subscale of the Wechsler Adult Intelligence Scale. 2. The pglgtionsnips in the house and outside of of the home will improve in the Experimental Group rela- tive to both Control Groups, as measured by the PES scales of Family Intergcpion and Getting Along With Others. 3. Mood and gifegp will improve in the Experi- mental Group relative to the two Control Groups, as measured by the "Affect Disturbance' area on the PACL and the Feeling & Moog scale on the PES. 4. The Self-esteem of the Experimental Group patients will improve more relative to the two Control Group patients, as measured by the Attitude Towards Self scale of the PES. 5. The §§tisfactory_use of free time will improve for the Experimental Group relative to the two Control 74 Groups as measured by the Use of Free Time scale on the PBS and the responses of the home managers on the CSQ. 6. The rates of readmission to State Facilities of patients from the Experimental Group will be lower than that of the two Control Groups. APPENDICES Appendix A Samples of Evaluation Material a. Progress Evaluation Scales b. Problem Area Check List c. Consumer Satisfaction Questionnaire EUMMIJNHY M£NML HEAUH EENHH CHIEFS OF SERVICE AND RAH CWRDINA : JOHN T. BOAZ. M.D. an" Ivan-Inn m KEITH E. LYON. PN.D. autumn: I m m continuum RONALD N. LUEHRIG. POLO. mac m mm ROBERT M. PATTERSON. “.0. emu nvcmnvms'r 826 W. KING STREET P. O. BOX 479 OWOSSO. MICHIGAN 48887 W 723-679I DAVID IHILEVICH. PH.D.. Dim £532 HENDERS: MAXINE ALLEN. Cans-um JOHN AUSTIN PETER HINDS LONDA KNAUFF JULIAN KUHN DAVID LORION HELEN MARUTIAK PHILLIP J. MOORE. ".0. UISE SflMSON. Anew. SAMUEL s, REITER “Am °°°"°"“"°" CLARICE SCHOCKE KENT . A D. A.c.s.w. 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