INTRODUCTION The importance of social skills is exemplified in the words of the famous Greek philosopher, Aristotle; “Man is by nature a social animal.” Deficits in social skills may be present in a range of psychiatric disorders, particularly in the more serious and persistent conditions, and have an influence on functioning across various domains. Recovery-oriented services represent a shift from categorical diagnoses of mental illnesses to look at functional parameters and also emphasise social inclusion and quality of life. Social competence can have a protective effect in the trajectory of severe mental illnesses and social skills training is an important part of the armamentarium of psychosocial interventions[] in rehabilitation settings. Sample The sample consisted of 380 consecutive inpatients and their accompanying caregivers, referred to PRS at a tertiary care government psychiatric hospital in a metropolitan city in India, during a two-year time frame. The day care facility (with about 40 outpatient day boarders), has a structured program with training in vocational, educational, social, independent living skills, yoga, leisure and recreational activities, cognitive, social and disability assessments, individual and family interventions, home-based rehabilitation, caregiver groups and liaison with community organizations for supported and competitive employment. The center is staffed by personnel, consultants and trainees from multidisciplinary backgrounds. Rehabilitation services are also extended to inpatients, referred by the treating adult psychiatry units, typically for vocational rehabilitation, establishment of a daily activity schedule, social skills training and cognitive rehabilitation.[] Inpatients are referred for varying durations (days to months) based on felt needs and practical issues like length of hospitalization.

Inpatient assessment proforma This semi-structured proforma was designed by the multidisciplinary team for the assessment of inpatients referred for PRS. It includes socio-demographic data such as age, gender, marital status; clinical data such as diagnosis, symptom status, drug compliance; and rehabilitation specific information including reason for referral, expected duration of admission, understanding of illness and expectations, expressed emotions, social functioning and the rehabilitation plan. Intake information is collected through interviewing referred inpatients, their caregivers and from documented information in the case file. The intake session is conducted by trainees from multidisciplinary backgrounds (psychiatry, psychology, psychiatric social work, or nursing). The Inpatient Assessment Proforma (IAP) is available on request. Social skills assessment screening scale The scale was developed by team members of PRS to screen for social skills deficits among referred inpatients and day boarders. The items were selected based on review of literature on social skills deficits in persons with severe mental illnesses, clinical experience with patients and caregivers in rehabilitation contexts and consultation with experienced practitioners working in mental health treatment or rehabilitation settings.

In the initial phase, the tool was administered on 59 inpatients with varied psychiatric diagnosis at their first contact with a mental health trainee at PRS.[] The 20-item Social Skills Assessment Screening Scale (SSASS), the rating scale and select item descriptions were finalized. The 20 items were grouped into three broad domains; nonverbal behavior and communication (4 items), verbal communication (6 items) and social behavior (10 items). Each item is to be rated on a 3 point scale (0 = inadequate, 1 = average, 2 = adequate). While most of the items are self-explanatory, further descriptions and examples were provided for nine items to facilitate clearer understanding of what the item intended to measure. The ratings are done based on information from the psychiatry treating team, observations and interviews with the patient and caregiver/s during the intake session. The patient's current level of intellectual functioning and symptomatic status are considered while completing the rating.

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Team members received brief training in the use of this assessment measure. The total score for the scale can be obtained by adding the scores for each item, with lower scores indicating greater social skills deficits. A qualitative understanding of specific skill deficits can also be obtained considering scores on individual items, across the three domains. Indian Disability Evaluation And Assessment Scale[] The scale was developed by the Rehabilitation Committee of the Indian Psychiatric Society (IPS) through a task force and later published as a government gazette.[] This brief five-point scale (0 = no disability to 4 = profound disability), is used to measure disability, specifically in persons with psychiatric disorders across four domains; self-care, interpersonal activities, communication and understanding and work. Global disability score is calculated by adding the “total disability score” and duration of illness (1 = 10 years). Global disability score between 1 and 7 corresponds to “mild disability,” and a score of 8–13 corresponds to “moderate disability,” a score between 14 and 19 corresponds to “severe disability,” and a score of 20 corresponds to “profound disability.” In a recent study, the Indian Disability Evaluation and Assessment Scale (IDEAS) scale demonstrated adequate internal consistency (Cronbach's alpha = 0.708) and construct validity among patients with residual schizophrenia.[].

Methods Institutional ethics committee clearance was obtained for this study. Sociodemographic and clinical details were recorded on the IAP and social skills assessment was done using SSASS by the trainees from multidisciplinary backgrounds posted at the PRS, for all inpatient referrals during a 2 year period. During this time, disability was assessed and documented using the IDEAS for a sub-sample of 94 inpatients. A retrospective chart review was carried out and the data was entered for analysis.

The members of the PRS team also obtained feedback about the utility of the scale, ease of administration and any changes required in the content and rating system of the SSASS from trainees who used the scale. Statistical analysis The data was analyzed by GNU PSPP Statistical Analysis Software 0.9.0-g745ee3.[] The demographic and clinical characteristics, and social skills ratings were represented using descriptive statistics including mean, standard deviations (SDs), frequencies, and percentages. Missing value imputation was not carried out. T-tests were used to assess the differences in the levels of social skills between groups based on gender (male, female), diagnostic category (psychosis, mood disorders) and locale (rural, urban). Internal consistency was assessed using the Cronbach's alpha. Pearson product-moment correlations were used to assess the associations between level of social skill deficits and the following variables; level of disability on IDEAS subscale and total scores, the duration of illness and age.

RESULTS A total number of 380 patients were assessed. The demographic and selected clinical characteristics of this sample are depicted in. The sample population was aged between 14 and 66 years of age with mean age of 30.68 years (SD = 10.08). The majority of patients were single, male, from middle socio-economic status and urban background, with up to 10 years of education. Psychotic disorders (schizophrenia, acute and transient psychotic disorders, schizotypal disorders, delusional disorders, schizoaffective disorders) formed the majority of the diagnosis (50.1%), followed by mood disorders (25.6%).

There was a wide range of duration of illness, ranging from 3 months to 38 years (M = 8.50 years; SD = 6.98). Demographic and clinical characteristics of inpatients referred to psychiatric rehabilitation services ( n=380) The pattern of social skills deficits is depicted in. The key social skills that were impaired across the three domains were largely in the area of Social Behavior.

The most prominent inadequacies concerned the patients' difficulties in reaching out to help others voluntarily (26.3%), difficulties in empathizing and understanding another person's perspective or emotions (25.8%). Difficulties were also most noticeable in the areas of expressing and sharing one's emotions (23.0%) and experiences (20.1%). In the domain of Verbal Behavior, the social skills most frequently rated as inadequate, pertained to the active initiation and engagement in a conversation (24.3%) and appropriate turn-taking during this interaction (19.5%). Nonverbal behavior and Communication was relatively less impaired and difficulties in the use of gestures and facial expressions emerged as the most commonly expressed concern (16.0%). Pattern of social skills deficits assessed using the social skills assessment screening scale ( n=380) Additional analysis examined difference in the level of social skills deficits based on gender (male vs. Female), primary psychiatric diagnosis (psychosis vs. Mood disorder), and residence (urban vs.

The results indicated the absence of any significant gender differences, t(260) = -1.08; P = 0.281 or any differences between patients from urban versus rural settings, t(221) = 0.97; P = 0.335. Social skills deficits differed between the two largest diagnostic groups of inpatients referred for rehabilitation services, t = −3.80 (189), P = 0.000. Inpatients diagnosed with psychosis (M = 24.28; SD = 11.86) had significantly greater social skills deficits when compared with those with mood disorders (M = 31.00; SD = 10.28). The deficits were prominent in the psychosis group in all the domains of nonverbal behavior and communication (M = 5.50; SD = 2.27 vs.

Military Microsoft Hup Program Code. M =6.46; SD = 1.92; t = −4.31 (358), P = 0.000), verbal communication (M = 7.22; SD = 3.89 vs. M = 9.21; SD = 3.37; t = −5.13 (351), P = 0.000), and social behavior (M = 11.11; SD = 6.41 vs. M =15.57; SD = 5.28; t = -6.01 (251), P = 0.000) as compared to mood disorders. There was no significant correlation between age and the level of social skills deficits ( r = 0.07; P = 0.264). Significant correlation between the duration of illness and the level of social skills deficits was absent ( r = −0.03, P = 0.709).

For a subset of the sample ( N = 84), IDEAS was used to measure disability. The Pearson product-moment correlations were computed between the SSASS total scores and the subscale and total scores on IDEAS []. The level of social skill deficits assessed on the SSASS were significantly correlated with the overall degree of disability on the IDEAS scale ( r = −0.53; P = 0.000). There were significant relationships with two of the four disability domains; Interpersonal Activities ( r = −0.61; P = 0.000) and Communication and Understanding ( r = −0.62; P = 0.000). Feedback and review of the Social Skills Assessment Screening Scale The review meetings in the multidisciplinary rehabilitation team examined the feedback about the SSASS as a brief screening method and a few modifications were made [].

The item descriptions for select items were expanded and some examples added to facilitate the rating process. The three-point rating system was changed to a simpler two-point rating of adequate/inadequate. This was based on the significant variations across raters in the way they perceived and used the ‘average’ rating point of the SSASS. The simpler rating system was also adopted to facilitate the ease of administration during the intake process. Open-ended questions were added to cover the following aspects: Patient and caregivers expressed needs for interventions in the domain of social skills, other factors that might potentially impact the current level of social skills, the rater's comments on possible reasons for discrepancies between the informants, or across contexts.

These included “nonskill factors;”[] premorbid personality, social anxiety, current psychopathology, medication side-effects, and limited opportunities for social interaction, which can influence social functioning. It was felt that a comprehensive evaluation would identify any “non-skill factors” which would be targets of intervention in addition to, or instead of, social skills. The modified version of the SSASS is provided in. DISCUSSION The results of the pilot study suggest that the SSASS could be a brief screening tool for use in mental health and rehabilitation settings. The brevity of the measures lends itself to integration into the routine clinical intake and processes.

Analysis of responses to individual items and the profile of deficits and strengths can help in defining individualized intervention plans. The inclusion of “nonskill factors”[] in the modified version of the SSASS can help identify additional targets for intervention. This initial assessment can be followed up by more detailed evaluation using role plays, observations and other methods. The results provided some support for the psychometric properties of the scale, with high internal consistency. Criterion validity was evidenced by the significant correlation with the IDEAS items that assessed disability in Interpersonal Activities and Communication and Understanding. The prominent social skills deficits were in domains related to verbal communication skills and aspects of social perception. The recognition of social cognition deficits, including theory of mind, social perception and knowledge and emotional perception and processing, in schizophrenia, is growing.[] Future efforts to expand the assessment of social functioning should include culturally appropriate evaluations of social cognition, particularly in persons diagnosed with schizophrenia.

Social skills deficits are not restricted to schizophrenia and may manifest in different ways in persons with mood disorders, even in the euthymic state,[] and across other many other psychiatric conditions. This pilot investigation revealed that there were significantly greater social skills deficits across all domains, manifested by persons with schizophrenia when compared with the mood disorder group. This was consonant with recent research that reported that individuals with schizophrenia had worse social skills on a role play assessment than those with bipolar disorder or major depression, with people with schizoaffective disorder in between.[] These initial findings are accompanied by a range of research and clinical implications.

Further work is needed to establish additional psychometric properties of the measure including inter-rater reliability and construct validity using other measures of social skills. The use of the tool with a larger sample and across varied psychiatric diagnoses would provide additional information about its potential scope and utility as well as differential typical deficit profiles across various psychiatric disorders. There is potential for the expanded use of the SSASS in clinical and rehabilitation settings. For instance, the use of SSASS items for rating social skills after role play enactments could also be explored. The current format of the SSASS does not lend itself to capturing small changes in social skills. The lack of descriptive anchor points makes the assessment vulnerable to subjective judgments of the rater.

The number of scale points could be increased to enhance its sensitivity and possible use as a measure of pre to post changes following social skills intervention. This pilot study provides initial promising results to support the use of the SSASS to train practitioners in screening for social skills deficits among patients in mental health and rehabilitation contexts. Social skills assessment screening scale Any other comments: Open-ended questions Q1. Does the patient indicate any need for social skills training? If yes, what are the areas in social skills that the individual wants to work upon?

Does the parent/caregiver think that the patient needs social skills training? If yes, what are the areas in social skills that they think the patient should work upon? Please comment on the premorbid personality of the patient. Can the observed social skill deficit/s (if any) be attributed to the following? Please describe: •. (ii) Variations in information about patient's social skills across different situations (e.g. At social functions, with males vs.

Females, with peers vs. With authority figures) Additional explanation for select items *4. Interpersonal distance refers to the patient's ability to maintain adequate distance while interacting or communicating with others. It also includes the ability to understand and respect interpersonal boundaries – while working or interacting. Inadequacy of this skill would be reflected in terms of intrusive behavior, being too close or too far apart while making conversation with others, etc. This item refers to the knowledge and use of turn-taking in a conversation in dyadic or group conversations, i.e., the ability to wait for one's turn to communicate, without intruding in a conversation or neglecting the other individuals' responses while communicating.

Communicating a message meaningfully refers to the ability to be able to express what one intends to express (considering the fact that the patient can do so). It includes the use of complete meaningful sentences to convey a message, rather than using minimal words and/or gestures. This item refers to the knowledge and understanding of what constitutes formal and informal situations. Formal situations include those like a workplace or a social or religious function. Informal situations are those which mostly involve one's peers; consist of activities such as playing, eating, etc. This item refers to the ability to regulate behavior according to different situations. Specifically, it involves the understanding that one must obey rules, be disciplined, show respect and work/communicate cordially in a formal situation; and on the other hand, be able to play, share experiences and communicate freely in informal situations.

Knowledge of appropriate manners would include the understanding as well as use of basic rules of courtesy – such as the use of “please”, “sorry”, “thank you”, “excuse me”, etc. In day to day communication and behavior. *14.This item refers to the ability to play with peers, work cordially or engage in activities with a group of other individuals.

This item refers to the using words of respect with authority figures in a conversation, and addressing peers appropriately while communicating with them. It also includes the understanding of what is not appropriate, such as abusive language, name calling and refraining from the use of such language. This item refers to the ability to share one's day to day experiences – such as how one's day was spent, the activities one was involved in, general events of the day etc.

This refers to the ability to understand another person's perspective/emotions. For example, understanding that engaging in behaviors such as teasing others, expressing anger either verbally or physically etc., are unpleasant for the individual being subjected to the same and would disturb/hurt them. It also includes the ability to understand another person's feelings and needs and responding appropriately – for e.g. Which Website Can I Download Nigerian Gospel Songs. If the caregiver is unwell.

Leading clinical psychiatry software systems offer: • Multiuser charting templates for evaluation • Subjective, objective, assessment and plan (SOAP) notes • Progress notes • Automated coding to ensure the highest possible E/M codes Additionally, psychiatric electronic medical records (EMR)—also known as psychiatric electronic health records (EHR)—often integrate, online scheduling, clinical documentation, prescription and lab writing, clinical reporting and other clinical and administrative tools for psychiatrists. E-prescribing in When selecting a psychiatry EMR/EHR, providers should consider other features necessary to improve efficiency and care at their clinics.

For example, some EMRs allow you to create and store custom, reusable notes in a database for quick retrieval during a patient encounter. In addition, many clinics will benefit from administrative features, such as a calendar application or patient scheduling for clinical appointments. We’ve created this buyer’s guide to help you gain a deeper understanding of the features and benefits of psychiatric practice software. Here's what we'll cover: Common Features of Psychiatry Electronic Medical Records Software Psychiatry workflow management Your EMR should mimic the way you, as a behavioral health specialist, operate. From first patient contact to initial consult, treatment and billing, make sure your software facilitates the point of care and supports, rather than interferes, with your opportunities for direct patient interaction. Advanced note management Psychiatrists need to be able to access their old notes quickly, to remind them of previous sessions. A psychiatry EMR should link progress notes directly to the treatment plan and allow for rapid note retrieval.

Psychiatry & behavioral health templates Specialty psychiatric SOAP notes templates include anxiety, depression, delirium, mania, psychosis, eating disorders, addiction, bipolar OCD, schizophrenia, suicide etc. GAF charts Ensure you can rate the social, occupational and psychological functioning of a patient through Global Assessment of Functioning (GAF). Monitor the degree of severity of psychosocial factors with a graphical depiction of ongoing progress. Psychiatric ICD-9 billing & coding Psychiatrists have their own unique terminology, required for both internal use and for external billing. A strong psychiatry software solution will provide detailed support for mental health billing, without the clutter of additional codes you don’t need.

The size of the practice, existing technology, connectivity and patient demographics may also play an important part in the decision-making process. Benefits of Psychiatry EMR Software Psychiatry software helps practitioners manage all the operational aspects of their practice—from patient scheduling and charting to billing and claim submission.

With the availability of both cloud-based and on-premise products, users have the flexibility of storing their data either on a company database or in the cloud. Cloud-based systems also offer greater ease of use for less technical users and minimize the need for in-house IT staff. Benefits that come with implementing psychiatry EMR software include: Electronic patient charting. Charting is the process of capturing all relevant patient information such as the patient’s name, age, gender, details about past medical history etc. Without a proper EMR system in place, this process requires paperwork and handwritten data entries, and pulling up past information means sort through paper records. An EMR system eases the process of data entry by allowing users to input information into patient records electronically. Some products also offer speech-to-text functionality, which allows users to update patient records using voice commands.

With patient charts stored in a centralized location, practitioners can easily search and access records for future reference. Patient notes.

Psychiatrists must log patient assessment notes and diagnoses during patient interactions. These notes also include other details such as progress reports and future treatment plans. An EMR solution helps practitioners record patient notes and store them in the practice’s database. In this case, speech-to-text functionality eases the process of note taking. Since patient records are stored in the database, practitioners can easily access past notes. Billing management.

The process of medical billing involves much documentation and paperwork. This becomes even more complicated if payment comes from a third-party insurance company or Medicaid. A billing management system pulls all the patient information directly from the patient records and autopopulates it into the billing documents, thereby saving significant time in data entry. Most products on the market offer two methods of billing management: Users can either manage billing tasks on their own or outsource it to a vendor.

Vendor outsourcing is becoming popular as it eliminates the need for additional staff to manage billing and claims processes. Both billing methods support different payment modes such as cash, Medicaid and third-party insurance claims. Integrated calendars and scheduling.

Scheduling patients can be a challenge for psychiatry practitioners. If a practitioner’s calendar isn’t up-to-date and available to receptionists and booking staff, overbooking can occur. An EMR solutions makes the process of scheduling more efficient by making real-time calendars of all practitioners available to the booking staff. The calendar is automatically updated when an appointment is confirmed. This functionality also allows staff to reschedule appointments in case the doctor is on unplanned leave or off work. Some EMR products in the market also offer automated reminders that sends text messages and email communication to patients regarding their upcoming appointment details. Third-party insurance management.

Practitioners who manually manage their operations face challenges when searching for medical codes to file claims with third-party insurance companies and Medicaid. With different diagnoses having varied ICD-10 and CPT codes, searching these codes can be time consuming. Further, any mismatch in codes can result in the claims being rejected.

An EMR software stores all patient codes in the database itself and provides an easy search option. As users start typing the disease and treatment names in the search box, they get suggestions in a drop-down list.

This eliminates the effort of manually searching for diseases and treatment codes. This functionality enables practitioners to send patient prescriptions to the pharmacy preferred by the patient. Patients can show their medical cards at the pharmacy and collect their medication from the counter. It also helps pharmacies ensure the availability of a medication prior to the patient’s visit. Patient portal.

A patient portal is a secure website where patients can access their diagnoses, medication, treatment plans and test reports. This simplifies the process of communication and allows practitioners to deliver test results as soon as possible.