Psych training gives aides necessary skills

Atlanta-based Norrell Health Care created a special psychiatric care training program for aides in response to the unique needs of its growing census of psychiatric patients.

"We have a need for caregivers with sensitivity toward behavioral issues," says Cathy Kelly, RN, BS, quality improvement manager for Norrell Health Care in Albany, NY. "It’s a little different dealing with psychiatric patients. You might be dealing with issues of the patient having crying jags, explosive behaviors, manic depressive swings, reactions to psychotropic medications."

Kelly spent several months developing a comprehensive training program with an 88-page manual that teaches aides how to recognize and handle various psychiatric symptoms and behaviors. Her program consists of eight hours of classroom study that can be delivered in one day or spread out over a week. Each year after their initial training, aides attend a three-hour inservice on psychiatric patients.

"They receive grassroots professional training," Kelly says. "We like to see this as something they would aspire for, and it’s not for everybody."

Course participants are screened, with emph asis on good attendance and dependability. Aides who exhibit social problems are not good candidates to work with psychiatric patients, she adds. Here’s how she developed the training program:

1. Research psychiatric disorders. She used various resources, including the library, the Internet, psychiatric textbooks, and nursing texts, and she spoke with experienced psychiatric caregivers. (See "Internet Connect," p. 190.)

Two good resources are the American Psychiatric Association’s Diagnostic Criteria from DSM-IV1 and The Essential Guide to Psychiatric Drugs2 by Jack M. Gorman, MD. Kelly also spent time reading children’s books on psychiatric illnesses because she wanted to put the clinical jargon into simple language.

2. Write a manual for aides. Kelly’s goal was to explain the clinical material in an understandable way. She used shorter words as substitutes for clinical terms whenever possible. Because some psychiatric terms have no substitutes, she included a phonetic spelling, an explanation, and several examples. (See sample, inserted in this issue.)

"When explaining a phobia to someone, you need to explain to them pretty graphically how bizarre it can be when someone is having a panic attack and becomes sweaty at the thought of crossing a bridge," Kelly says. "So you ask students what gets their own hearts pounding or suggest they imagine a time when they’ve been really terrified and transplant that feeling to someone who has an irrational fear."

Kelly also might use a popular movie to illustrate a certain disorder. For example, in the 1995 movie Copycat, Sigourney Weaver’s character, who suffered from agoraphobia, was so afraid of open spaces that she had trouble leaving her house even to escape a killer.

3. Instruct aides about care of psychiatric patients. Norrell Health Care’s manual consists of two books. One is for the instructor, and the other is for the students. The student books include areas where aides can write notes. The instructor’s manual has two parts, and one part includes everything that is in the student’s manual.

Here’s the course description: "This program is designed to provide the experienced home health aide with additional didactic training in the specialty of behavioral/mental health home care services. The behavioral/mental health training program provides special instruction regarding the home care of clients with affective, anxiety, eating, personality, and thought disorders. The program is a combination of lecture, discussion, video, question and answer, and a demonstration of care skills. Following the didactic portion of the program, the home health aide must successfully demonstrate therapeutic communication skills."

By the end of the training program, home health aides must meet these objectives:

• Describe the mental health care continuum.

• Discuss the types of mental illness that may be seen in the community.

• Discuss what to expect on the Aide Plan of Care for specific diagnoses.

• Discuss diagnostically specific interventions.

• Describe the components of therapeutic listening.

• Discuss and demonstrate behavioral/mental health care skills.

• Recognize their own feelings regarding mental illness.

• Identify what must be recorded and reported about problematic client behaviors.

The second part of the instructor’s manual highlights the important sections and includes teaching tips, resource material, and psychological inventories. The inventories are complex; one might show how psychological testing is done or how psychotropic drugs are used, for example.

Instructors emphasize that aides should err on the side of caution with psychiatric patients. Just because these patients don’t have wounds or obvious physical ailments doesn’t mean everything is fine. "That’s why psych patients are often left in the lurch, because no one understood their needs," Kelly says.

Home health aides need to understand the basis of abnormal behaviors before they can deal with them therapeutically, she adds.

In addition, instructors teach aides how to handle patients who may be experiencing hallucinations by validating their fears but making it clear the frightening images aren’t real, Kelly says. "This helps focus and reorient the client. It’s also helpful to attempt to divert the client’s attention by involving them in some type of diversional activity."


1. American Psychiatric Association. Diagnostic Criteria from DSM-IV. Washington, DC; 1994.

2. Gorman JM. The Essential Guide to Psychiatric Drugs. New York City: St. Martin’s Press; 1990.