874 August 1988 Vol. 39 No. 8 Hospital and Community Psychiatry Training Chronic Mental Patients to Independently Practice Personal Grooming Skills Stephen E. Wong, Ph.D. Stephen G. Flanagan, Ph.D. Timothy G. Kuehnel, Ph.D. Robert P. Liberinan, M.D. Ron Hunnicutt Jean Adams-Badgert Schizophrenic patients typically have poor grooming and self-care skills, which binder their social relationships and their chances of successful adaptation in the com- munity. A practical and inexpen- sive program for teaching groom- ing skills to hospitalized chronic mental patients has been devel- oped in a California state hospi- tal. Patients are also taught to evaluate their grooming behavior and to car?:)’ out grooming activi- ties independently. Grooming defi- cits and improvements are rated on an 1 1 -category performance checklist. Two small-scale pilot studies showed that the program Dr Wong is director of the be- havioral treatment unit at North- east Florida State Hospital in Macdenny. Dr. Flanagan is di- rector of psychology at John Urn- stead Hospital in Butner, North Carolina, and clinical associate professor in the department of psychology at the University of North Carolina in Chapel Hill. Dr. Kuehnel, Dr. Liberrnan, Mr Hunnicutt, and Ms. Adams- Badgett are associated with Camarillo (Calif.) State Hospi- tal. Dr. Kuehnel is also assistant professor-research, and Dr. Lib- erman is professor, in the de- partrnent of psychiatry and biobe- is efficacious and that nursing staff can effectively apply the pro- cedures; in another study, the pro- gram u zs implemented on a large psychiatric unit with minimal staffing and resources. One of the characteristic signs of persons with schizophrenic disor- dens is deterioration in personal grooming and self-care skills. This deterioration stigmatizes them as having a mental disorder, interferes with their social relationships, pro- longs institutional stays, and may endanger their physical health (1,2). Studies have documented the im- portance of premorbid and post- morbid social competence in such areas as grooming and appearance in determining psychiatric patients’ successful tenure in and adaptation to the community (3-5). A conceptual model for explain- ing the course of schizophrenia in terms of “stress-vulnerability- havioral sciences at the Univer- sky of California, Los Angeles. Address correspondence to Dr. Liberman at the Carnarillo- UCLA Research Center, Camar- jib, California 9301 1. This re- search was supported in part by NIMH grant MH30911 to the UQA Qinical Research Cen- ter for Schizophrenia and Psy- chiatric Rehabilitation; Na- tional Institute of Handicapped Research grant G008006802 to the UCLA Rehabilitation Re- search and Training Center in Mental Illness, and NIMH grant MH-R20-C to Carnarillo State Hospital. coping-competence” (6,7) suggests that patients’ self-care skills could be improved through systematic training procedures. This concep- tual model is reflected in the grow- ing popularity of efforts to teach skills to the psychiatrically disabled as part of an emphasis on psychi- attic rehabilitation. Well-controlled and efficacious training programs to enhance social, vocational, and living skills have been published in the recent scientific literature (6,8-10). Surprisingly, however, there are few controlled investiga- tions of the impact of a complete personal appearance training pro- gram for psychiatric patients (9). Skills training approaches that employ reinforcement, modeling, and prompting procedures derived from behavioral learning pninci- pies have been used to improve a variety of self-care and grooming skills (8,1 1). Patients’ grooming achievements have been symboli- cally reinforced by posting stars on a publicly displayed chart (12). Some successful training programs have made food contingent on ap- propniate grooming ( 1 3). Social re- inforcement has been shown to be as effective as more primary tangible reinforcers in motivating patients to lean appropriate groom- ing (12,14). Token economies have also been effective in structuring prompts and reinforcement to im- prove self-care (15-17). In one token economy program for psy- chiatnic inpatients, staff increased patients’ grooming behaviors such as face washing, hair combing, shav- ing, tooth brushing, and dressing neatly by prompting these re-