role plays, and direct behavioral observation, the assessment yields information about the psychiatrically disabled person's current deficits, psychopathology, skills, and supports, as well as the skill level demanded by the living, learning, or working environments in which the patient wishes to function. The assessment information enables the rehabilitation practitioner to work with the patient and family member in the planning phase to develop a rehabilitation plan that specifies how the person or the person's environment must change to achieve the goals of rehabilitation. With respect to changes in the person, the plan develops the skill steps the person needs to raise his or her level of functioning to the level required by the environment. With respect to changes in the person's environment, a sequential plan describes what and how the necessary coordination, advocacy, and modifications are to be made. The rehabilitation plan also identifies the persons (e.g., practitioner, patient, agency, and family member) responsible for implementing the various parts of the plan. In the intervention phase, the rehabilitation plan is implemented to increase the person's skills and to make the environment more supportive of the person's functioning. These interventions can lead to the achievement of the rehabilitation goals, first identified during the assessment phase. Repeated and regular monitoring of the change process informs all concerned about goal attainment and enables clinical decisions to be made about continuation or change of interventions and goals. Psychiatric rehabilitation is the recovery of social and instrumental role functioning to the fullest extent possible through learning procedures and environmental supports. When restoration of functioning is limited by continuing deficits and symptoms, rehabilitation efforts aim at helping the individual (1) acquire living, learning, and working environments that are compensatory; and (2) adjust to the level of functioning that is realistically attainable. Because of the limitations of currently available training methods, patients with more chronically disabling disorders, such Downloaded from by guest on 23 November 2021 VOL. 12, NO. 4, 1986 555 as schizophrenia or organic brain disorders, may be unable to reestablish specific impaired or lost skills. In such cases, alternate compensatory skills and environments, such as learning to function in sheltered employment and residential settings, would be the focus of rehabilitative efforts. With chronic psychiatric disorders, some amount of continuing symptoms and residual impairment makes necessary the acceptance of disability and the identification of new, attainable goals. Learning how to cope with symptoms, manage medication, and utilize professional resources when necessary become important targets for rehabilitation. When deficits preclude gainful employment, the patient and family need assistance in generating alternative types of meaningful activity, social contacts, and daily structure. While persisting symptoms may limit the level of functional engagement in life, the reciprocal also holds— namely, the more that rehabilitation improves the patient's social and role performance, the more likely that symptoms will be held in check. Rehabilitation begins immediately after the stabilization of an acute episode or exacerbation of psychiatric disorder which usually results in the loss of social and role functioning. The goals of rehabilitation professionals are to sustain symptomatic improvement over the long haul; establish or reestablish interpersonal and independent living skills; and help the individual reach a satisfactory quality of life. Comprehensive rehabilitation involves assessment, training, and modification of environments in areas relevant to personal and community life. Professionals contributing to psychiatric rehabilitation include psychologists, vocational rehabilitation counselors, occupational therapists, recreational therapists, nurses, social workers, psychiatrists, and mental health paraprofessionals. The professionals are careful not to overlook the natural caregivers in the patient's living environment—for example, peers, relatives, and operators of board-and-care homes. (Vaughn e