HOPES is an evidence-based skills training program developed for people with a serious mental illness such as schizophrenia. The HOPES program targets interpersonal skills in areas such as community living, social functioning, as well as skills to better manage health and wellness. HOPES was developed and evaluated in the early 2000’s by Sarah Pratt, PhD, Kim Mueser, PhD, and Stephen Bartels, MD, MS at the Geisel School of Medicine at Dartmouth, in order to improve skills in these areas with the goal of improving enjoyment and quality of life and maintaining independence in the community.
People with schizophrenia often experience psychiatric symptoms during late adolescence and young adulthood, a time when critical social skills and other skills needed to live successfully in the community are still developing and being refined. Interruptions and challenges in the development of interpersonal skills are common in people with schizophrenia and can contribute to difficulties across a range of different areas of life. For example, impaired skills for conversing with others and clearly expressing thoughts, feelings, concerns, and preferences can limit the ability to make friends and get close to people, leading to loneliness and social isolation, which can impact both mental and physical health functioning. Poor skills in these areas can also make people less effective when interacting with medical providers, such as difficulty describing distressing symptoms or getting a provider to pay more attention to a problematic medication side effect, limiting the quality of the care they receive and contributing to worse health outcomes. The long-term impact of limited social skills can include inability to get needed social support, and/or difficulty advocating effectively across a range of situations (such as interacting with health care providers, landlords, or employers), which can impact a sense of integration or belonging in the community. As people age and naturally need more help from others with getting their needs met, this lack of integration into the social fabric of the surrounding community can threaten independence and increase the chances of placement in more supervised settings, such as congregate living, nursing homes, or state hospitals.
The year-long HOPES curriculum consists of weekly classes and monthly individual meetings (with a supportive other person) to review progress towards goals. In each class, the leaders and participants discuss and practice a step-by-step approach to learning a different skill each week. The class environment provides an opportunity to role-play and practice each skill in a supportive environment of peers and leaders. Each week, participants also identify an “action step” to take outside of class to either practice the skill on their own or take a step towards a personally meaningful goal. The skills taught over the year cover eight general areas of functioning, including:
- Communicating Effectively
- Making and Keeping Friends
- Making the Most of Leisure Time
- Living Well in the Community
- Healthy Living
- Intimacy and Dating
- Using Medications Effectively
- Making the Most of Healthcare Visits
In addition, once a month, one of the HOPES leaders meets with each participant and a self-selected supportive other person (such as a family member, friend, case manager, or other treatment team member) to review progress in the program. The rationale for involving a supportive other person in the HOPES program is that participants benefit from having another person in their life who can help them use skills taught in the program and take steps towards their goals. During these monthly meetings, the skills taught in the HOPES classes over the past month are discussed and steps the participant has taken towards their goals are reviewed. Then, plans are made regarding the participant’s practice of specific skills and further steps to be taken towards goals, and potential assistance that will be provided by the supportive other person.
The HOPES program is provided with the aim of supporting the learning, personal interests, desired life changes, and recovery of participants. Our team has been delivering HOPES for over 20 years to improve health and quality of life for people with schizophrenia and related conditions. We have seen many HOPES participants reach their personally meaningful goals, and ultimately live healthier, happier, more independent lives.
Sarah, Kim, Meghan
Sarah Pratt, PhD, Kim Mueser, Phd, & Meghan Santos, LCSW