Saturday, 15 January 2005 - 12:00 PM
This presentation is part of: Poster Session II
Effect of Neurocognitive Impairment on Community FunctioningDeborah Gioia, PhD, University of Michigan School of Social Work.
Purpose: The aim of this NIMH-funded study (RO3 MH64686) was to understand whether there were observable and self-reported differences in "real world" daily living tasks between individuals living in the community and diagnosed with schizophrenia, half of whom had been designated as high functioning and half of whom were designated as low functioning based on a summary score derived from a battery of neurocognitive lab measures. This exploratory study utilized ethnographic methods to understand the internal and external strategies used by all persons to maintain an independent life in the community.
Method: The researcher was "blind" to the neurocognitive status of the 10 individuals who were entered into the study from an NIMH parent protocol. Real world tasks (e.g. laundry, shopping, money management, scheduling appointments, transportation) were observed during a 2-3 day follow-along by the researcher. During the follow-along many questions were posed to provide a context for the activity and to allow each individual to speculate whether the illness process had an effect on the way they performed the task. In addition to participant observations each individual was asked a battery of questions related to symptoms, self-esteem, quality of life, vocational and social functioning. The final phase of the research will be to pair the neurocognitive status with each individual in order to confirm or refute the data from the ethnography.
Results: In the ethnographic analyses, it was clear that all individuals made accommodations to their illness in order to achieve the best possible community functioning. Persons with higher neurocognitive functioning had lives that were similar to their non-ill peers who were in a low socio-economic position. Under a limited budget community survival strategies were paramount. Those with more cognitive disability relied on family members or staff in residential programs for reminders about daily activities. Often individuals displayed a range of functioning across activities. For example, one individual who was very attentive to his public appearance and functioned effectively as a peer counselor in a day treatment program, was very neglectful of his apartment and keeping food safe to eat.
Implication: It is an important effort to translate lab-based information into real world settings. This type of research is time-consuming and therefore not done very often. From a psychosocial rehabilitation standpoint, it is critical to learn what compensations persons with mental disorders make in order to live normally. The ability to speculate on one’s cognitive abilities is not easy and requires a researcher to ask key questions during the performance of the activity. The field of cognitive remediation is based on developing usable strategies that enable persons to complete their tasks with a low level of disability. Case-management, medication management, supported employment, and supported education will benefit from the knowledge provided by this study.
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