Supported Education Practitioners: Agents of Transformation?

ABSTRACT

Interviews with adult mental health in- and out-patients attending a psychiatric hospital-based supported education program, and their program staff and volunteers, demonstrated that while an informal program structure had initial success in increasing student confidence and independence, the subsequent expansion of the program requires formalizing it using adult and transformative education protocols to increase literacy gains. We argue that professional development in adult education showing the value of transformative learning for staff can complement their occupational therapy and mental healthcare training, so that the empowerment and identity transformation can be increased for these vulnerable students.

KEYWORDS:

• Andragogy
• mental illness
• professional development
• supported education
• transformative learning

Introduction

This article presents the findings from a project examining the educational and social impacts of a supported education (SEd) program designed for inpatients and outpatients 21 and older at a psychiatric hospital. Because those living with mental illness are typically marginalized within their communities and educational systems (Aguilar‐Gaxiola, Alonso, Lee, & Bedirhan Ustun, 2007; Hitlin, Erickson, & Brown, 2015; Kessler, Amminger, Leach, & Butterworth, 2007; Kessler, Foster, Saunders, & Stang, 1995), increasing educational accessibility and decreasing social isolation creates greater community equity for this group. SEd has, therefore, evolved as a best practice to support the educational needs of adults with mental illness. During the 1970s in the United States, SEd evolved outside of hospitals in residential settings in the community. Day services began to emerge, including clubhouses, day treatment programs, partial hospitalization programs, and vocational rehabilitation services (Rogers, Kash-MacDonald, Bruker, & Maru, 2010) These SEd programs allowed students to attend programs in the community, on college and university campuses, or in hospitals, while being supported by a combination of mental health services and academic accommodations (Mowbray et al., 2005). Unlike the United States where SEd was first conceived in mostly post-secondary and community settings, Canada has been slow to adopt the practice and has very few SEd programs in post-secondary and community settings. Instead, SEd programs emerged in Canadian hospitals sometimes with commensurate community hubs (Leonard & Bruer, 2007) Our study of SEd is, therefore, one of the few Canadian-based studies of such a program that is solely hospital-based. The psychiatric hospital program we examined, however, still offered some of the accommodations that were related to traditional SEd programs in the United States. These similarities include receiving support to improve general education skills (math, reading, writing, or computer skills), pursue high school credits, or work toward attending a college or university, and develop the skills needed for success in a post-secondary setting (Anthony & Unger, 1991; Arbesman & Logsdon, 2011; Holter & Paul, 2004; Manthey, Rapp, Carlson, Holter, & Davis, 2012; Mowbray, Megivern, & Holter, 2003; Unger, Pfaltzgraf, & Nikkel, 2010). Our study was designed to explore how SEd hospital programs, in particular, can enhance students’ academic skills, personal and social resources, and can lead to positive impacts on their day-to-day lives. In addition, we wanted to determine how educators can better contribute to the social and economic well-being of their students in a transformative way.

The aspect of our project that we are examining in the current article is how this new student identity can be the basis for transformative education (Arbesman & Logsdon, 2011; Bellamy & Mowbray, 1998; Mezirow, 2012). We combine our research with those of others to argue that both well-tested andragogy practices and the concept of transformation theory offer insights that can improve outcomes for students and help those who facilitate their learning to do so with intentional purpose. We believe that the findings we present in the current article support this argument and are important for any SEd program that is housed in a psychiatric hospital and especially those that include facilitators not trained in adult education.

In the present article, we first present the premise of our argument, which is the fundamental importance and value of transformative learning, and then we describe the SEd project and some of its main findings and themes found in our student and staff and volunteer interview results as they relate to transformative learning. We then address how adult education models of pedagogy (andragogy) can create transformative education to improve the SEd program and those like it, and conclude by showing the benefits of the application of transformation theory to SEd for both students and educators in SEd programs.

The value of transformative learning

SEd in a hospital setting can act as an aid to student recovery and as a method for those with mental health issues to fight social isolation, and we argue that a SEd focus on transformative learning is the most effective way to do this while also improving literacy levels. Our project is built on the premise that education is a social good and that transformative learning makes education meaningful and empowering to students. The value of transformative education is its ability to create learners that will not be as overwhelmed by change because they can develop a learner’s defense system (Illeris, 2014). We define transformative education as (Mezirow, 1996, 1997, 2012) education for adults returning to school that is based upon self-examination and critical reflection to address alienation and facilitate relationships with others sharing the same experience. Adult learners explore options, build self-confidence, acquire new knowledge and skills, and reintegrate into society with revised perspectives (Kroth & Cranton, 2014). We also believe in operationalizing this transformative learning by what Kroth and Cranton (2014) refer to as the creation of a climate that critically questions points-of-view. They describe transformative learning activities as ones that allow for self-reflection, such as journal writing, art-based activities, or role-playing exercises that bring personal experiences into the classroom. Wang and Cranton (2013) also believe that transformative learning allows students to transform themselves through technology.

Critical reflection and technological knowledge allow students to fully engage in the world and to have meaningful learning experiences. This is supported by andragogic research on transformative learning (Illeris, 2014; Mezirow, 2012; Taylor & Laros, 2014; Wang & Cranton, 2013). Our premise is that this engagement and connection between life inside and outside classrooms should be the goal of SEd programs because ultimately this will be the best way to motivate students and to give them the tools to succeed in the world. This is because it can create personal growth, new social and economic connections, and what Cranton (2016) called the “art of questioning” which is the core of self-knowledge and understanding.

The initiation of a SEd research project

After initial discussions with the manager and program coordinator of a SEd program in a large Canadian psychiatric hospital, we developed a research agenda designed to better understand the impact of this SEd program on the students’ quality of life, motivation, and educational improvement and to determine if the program had the necessary structure for continued growth and success. We also wanted to gain insights into the strengths, weaknesses, and structure of the program and its value and impact from both the student and the staff point-of-view. In order to accomplish this, we interviewed SEd students (who were over 21 and either in- or out-patients of the psychiatric hospital), SEd program staff and SEd program volunteers. These interviews were anonymized and all identifying information was removed before they were analyzed. We received Research Ethics Board (REB) approval from our university and from the psychiatric hospital and this approval was contingent on our ability to keep the identity of interview subjects private.

The case study: Canadian hospital-based SEd program

The SEd program that we analyzed as our pilot project/case study is conducted in a dedicated classroom in a psychiatric hospital Monday through Friday, 10:00 am to 12:00 pm and 1:00 pm to 3:00 pm by five staff and two volunteers (rotating to 10 volunteers total). The students are either in or outpatients, 21-years-of-age or older, and self-refer to the program with the recommendation of outside counselors, friends, or family. Each student has either individual instruction from a staff member of volunteer or works independently with support as needed. Depending on their learning plans they complete tasks which include high school subjects, computer-based online modules, or reading or math exercises. During the first 6 years of this SEd program, enrollment more than doubled, increasing from about 30 in 2006 to about 80 in 2012, and then stabilized at 80–100 each following year. These numbers are approximate as the numbers fluctuated depending on the time of the year, with summer typically being a time when attendance is sporadic. The numbers were also affected by changing psychiatric medical conditions and family situations that made it more difficult to attend the program.

The SEd program was originally designed to follow a psychosocial rehabilitation model which includes normalization, self-determination, support and relationships, hope and recovery, and systems change. At the same time, the program also drew on the Choose-Get-Keep (CGK) model to empower students to choose their own goals and learning objectives, to secure and sustain enrollment, and to maintain an acceptable level of success until their goals are achieved (Mowbray et al., 2005; Soydan, 2004). The CGK model of psychiatric rehabilitation and SEd was meant to emphasize person-centered goals and focus on participant process rather than on practitioner activity (Sullivan, Nicolellis, Danley, & MacDonald-Wilson, 1993). The use of the CGK model is a necessary component of a strong SEd program. However, equally important is professional development (PD) in adult education to help facilitators to implement the model and to follow andragogic practices, such as use of appropriate resources and curriculum, ongoing program growth and success might be limited.

Student interviews

This was a pilot study and we report the results in the current article of the 42 regular stream students. We have separately analyzed results for five English language learners, and these results will be published separately. We anticipated some negative reactions to the interview questions; however, most of those interviewed seemed eager to discuss their learning and none of them asked to withdraw during the interview process. Most answered all of the questions, but some chose not to answer questions about medication, diagnoses, and ethnicity. Interviews took place in a private room in the SEd classroom area that with a window for security, but a closed door for privacy. One researcher and one research assistant were present during the interviews and we audio recorded the interviews, as well as filing out interview guides. Student interviews took an average 30 minutes.

Methodology

Using a mixed method approach, we simultaneously collected quantitative and qualitative data from our student interviews. During the interviews, we asked questions that were closed-ended to gather responses that could be quantified (i.e., questions about demographics such as age, sex, and their self-perceived literacy improvements), questions that had both quantitative and qualitative elements (i.e., questions about confidence, independence, and feelings about job or life prospects), and questions that were open-ended about the strengths and weaknesses of the program.

Responses to the questions were transcribed verbatim from the audio recordings. For the quantitative analysis, we used descriptive statistics within statistical package for the social sciences (SPSS) (IBM Version 22, 2013). For the qualitative analysis, we identified themes by analyzing the interview transcripts both manually and with NVivo software Version 10 (QSR International Pty Ltd., 2012).

Results: Potential barriers to transformative learning

The demographic data (see Table 1) shows a fairly even split between out- and in-patients. There were more male program participants than female, with a mean age of 33. None of our interviewees had full-time jobs, and most were not involved in activities in their community outside of the hospital. Most students were not married or in personal relationships, supporting the need for transformative learning that concentrates on engagement.

Table 1. Demographics of student interview participants (self-reported).

Characteristic	N	%
Hospital Status*
Inpatients	18	42.9
Outpatients	21	54.8
Undisclosed	1	2.3
Gender
Male	30	71.4
Female	12	28.6
Marital status
Single	41	97.6
Married	1	2.4
Education
Grade 9–10	16	42.1
Grade 11–12	13	34.2
Grade 13	1	2.6
Some College	7	18.5
Some University	1	2.6
Age (years)
21–33	25	59.5
34–53	17	40.5

Our research identified consistent, self-reported barriers to education; yet those barriers provided motivation for attending the program. During our open-ended questions, our participants had consistent responses of negative educational experiences in the past, withdrawal prior to graduation, or sporadic attendance at school because of their mental health challenges that were described as lack of interest, addiction issues, or frustration. This resulted in a theme entitled Discouraging Educational Past. The reason for not continuing studies or returning to them earlier was explained by the theme of Learning Anxiety. Similar barriers have been identified by other researchers (Leach & Butterworth, 2012; Megivern, Pellerito, & Mowbray, 2003). Yet, like those interviewed by other researchers (Collins, Bybee, & Mowbray, 1998; Corrigan, Barr, Driscoll, & Boyle, 2008), the students in our case study valued the opportunity to resume their studies. Almost all interviewees spoke of the importance of education resulting in a theme entitled the Value of Education.

A little over half (52.2%) of the students identified their mental illness as a barrier to pursuing education. While medication was identified as being a barrier by 23.9%, others noted that medication was helpful in allowing them to pay attention and to think clearly. Some students (34.8%) identified having learning disabilities, and described those disabilities as a barrier to their educational pursuits. Due to privacy rules, we had no way of learning more about the nature of those disabilities. Social isolation was identified by 30.4% of interview subjects as a barrier. Finally, some students stated that, other than this hospital-based program, it was not easy to find local programs that were suitable for persons with mental illness. The SEd program was identified by students as helping individuals to overcome many of these barriers because it was in a space that was accepting and supportive of those living with mental illness and created a sense of community. The improvements that form the basis for this will now be detailed.

Results: Improvements and persistence

Our interviews revealed that there were improvements in self-confidence and independence. Improved self-confidence was reported by 85.7% of the respondents and an increased sense of independence was reported by 81% of those interviewed. The main theme emerging from the open-ended questions was Supportive Environment. This reflected the various ways in which the students interviewed felt supported in the classroom, enjoyed the staff and identified them a program strength and enjoyed the other students that they met.

These gains occurred in spite of the fact that less than one-quarter (23.8%) of interviewees felt that they had reached their educational goals. Indeed, almost three-quarters (73.8%) felt that they would eventually achieve their goals, demonstrating both hopefulness and persistence among students and their desire to transform their identities even if they have not done so already. In general, students had a favorable view of the SEd program. However, the increases in confidence, independence, and socialization detailed above were far greater than the self-reported increases in math, reading, writing, and other skill levels.

Despite the self-reported increase in confidence, independence and improved feelings toward education, levels of literacy education did not increase to the same degree: reading skills (38.1% of students reported improvements), writing skills (38.1% of students), and mathematical skills (31.7% of students). However, all students did report improvements in study skills.

Discussion of student results

Persistence to continue their studies and the value placed on education shows students’ openness to transformative learning and the desire to positively impact their identity and skill levels. Almost all showed improvement in confidence, independence, and study skills, suggesting that most students would be open to transformative learning. We believe that these improvements were the result of the main strength of this program—the staff and classroom environment represent a safe and caring space, as well as a positive and accepting learning culture for the students and the strong psycho-education skills of the staff.

Research on goal setting demonstrates that having social connections, such as friends and relatives, help individuals to achieve their goals (Corrigan et al., 2008; Urdan & Maehr, 1995). It is no different here—having a sense of community and connections in the SEd learning environment—especially for these students who may feel somewhat socially isolated because of their mental illness, was identified as being helpful in encouraging the students we interviewed to attend the program and persist in achieving their goals. This is another strength of the program as the staff are able to create a supportive atmosphere.

The somewhat low level of improvement in literacy skills reported by both students and tutors could suggest that there is a need for more effective andragogy beyond psycho-education. With only about one-third of students reporting any literacy improvements it seems there is need to examine the effectiveness of the educational component of the program beyond the socialization and support component.

The students’ academic results raise an important question: Is the limited progress toward educational goals despite their social and emotional gains due to lack of andragogic skills on the part of the staff or to unrealistic goals having been set by students upon enrollment in the program? It seems that both factors may be implicated in the explanation. Clearly the staff and volunteers must keep students motivated, while also ensuring that their goals are realistic. Successful SEd programs must encourage self-confidence, hopefulness and persistence, while also educating students about the reality of their prospects (e.g., the inability to become a bonded or licensed worker in some fields) and their level of skills by setting goals that are attainable (Bellamy & Mowbray, 1998; Corrigan et al., 2008; Hoffmann & Mastrianni, 1993; Isenwater, Lanham, & Thornhill, 2002; Leonard & Bruer, 2007; Mansbach-Kleinfeld, Sasson, Shvarts, & Grinshpoon, 2007; Unger, 1993). This highlights both a limitation of the program and a need for transformative education.

Limitations of student results

There a number of limitations that could have potentially affected our study and the results of our student interviews. The first of these limitations is true for any qualitative study and that is the subjective human element of the findings. We did not verify any student claims or statements, but were aware that these are personal perceptions and what they chose to tell us. The increases in the skill levels of participants were also self-reported. We are also aware that because these students have psychiatric disabilities their perceptions of themselves could be affected by mental illness or medication. While we recognize the limitations as researchers, we believed it was crucial to highlight student voices, opinions and observations to see what motivated them to seek out SEd and how SEd had improved their quality of life.

Staff and volunteer interviews

The classroom is housed in the Vocational Rehabilitation Unit and at the time of our research project the program it had 5 staff and 9 to 10 volunteers (2 of which were in the classroom at any given time) and was managed by an occupational therapist. Although many of the initial SEd services were provided somewhat informally by trained vocational rehabilitation counselors rather than educators with provincial teaching certification, there was an effort to follow some of the provincial education curriculum. We conducted private interviews with staff and volunteers in a private room with only one researcher and the staff or volunteer present. All interviews were audio recorded.

Methodology

To understand impressions of the culture within the program and the challenges faced by staff and volunteers, the interviews with staff (n = 5) and volunteer tutors (n = 9) used more open-ended questions than the interviews with the students. We collected demographic data and asked questions about their training, educational experiences with their students, and the value of SEd for the students in their program. We posed questions about the strengths and weaknesses of the program and potential improvements. Finally, we asked questions about the outside perceptions of mental health. We analyzed the qualitative data from these interviews manually and using N-Vivo 10 to find overall themes (QSR International Pty Ltd., 2012).

Results: Benefits for students

In general, the interviews illustrated that most staff and volunteers felt that the program was useful for the students who were attending it, but that there was room for improvement. During the open-ended interviews they perceived a number of benefits for students in the program. These were self-esteem, aid in recovery, confidence, and independence, as well as study skills and structure for their lives. The staff and volunteer interview subjects identified the strengths of the program as the individual attention each student received through the one-on-one instruction, the flexibility offered to the students, the program environment, and the continuity and support provided to students.

Results: Challenges for the SEd program

Possible changes or challenges to the program were also identified including the need for resources, the need for staff to be specialized in all subject areas, and the need for more organization and coordination. They specifically identified a very high demand for computer skills classes by students, but there were few staff or volunteers who said they were comfortable teaching and using those skills. They also said that they were not comfortable with high school level math and science. Similarly, staff said they did not have access to PD in the field of adult education unless they sought it out on their own time, but none reported this as part of their training. Staff coordination issues also emerged from our interviews because they said they were often working with the same students but had different styles and foci for their studies. Volunteers said they participated in the hospital’s general orientation and training about safety and rules, but did not receive training specific to their work as educational tutors. We will now expand on how and why transformative learning and andragogy can help instructors in hospital SEd programs to teach their students more effectively.

Discussion of staff results: Psycho-Educational strength

The educational training for occupational therapists provides a good background in psycho-education, and this will provide a good grounding for more specific andragogic training and transformational learning. Steed (2014) defines psycho-education this as any planned instruction intended for a client with emotional challenges in order to: (1) increase the client’s skills and knowledge necessary for participation in daily occupations; and (2) improve the client’s overall sense of well-being and satisfaction with life roles. An advantage to this definition is that it includes occupation-based instructional strategies, an essential element of occupational therapy best practice (p. 129). Occupational therapists’ ability to deliver knowledge of practical skills, promote emotional well-being, and enable socialization with an understanding of social roles helps students be prepared for SEd and transformational learning. The strength of this SEd program is the psycho-educational training that those involved in vocational rehabilitation have had. The strong psycho-educational outcomes are witnessed by both our student and staff and volunteer results. This is a strength can be built upon with the addition of PD in adult education and through using the empowerment of transformative learning.

Discussion of staff results: Connecting the SEd program to andragogy

A challenge for any SEd program is having instructors trained in both the mental health field and in adult education, and this need for greater staff resources was identified in our staff and volunteer results. In our SEd case study, only one staff member had a degree in adult education, while one other staff member was a provincially certified teacher for the secondary level/high school. The three remaining staff members were trained as occupational therapists and one had further training as a mental health nurse, but had no formal training in adult or provincial educational practice. They did not see this as a difficulty, but we felt that this lack of training in any SEd principles or pedagogy, in particular andragogy, meant they are not as effective in working with students and their learning plans as they potentially could be. Through our interviews, we identified a lack of adult education-based training and PD opportunities for staff and volunteers as the most significant weakness of the program in terms of educational outcomes.

For SEd staff, PD opportunities in adult education are important for moving the program toward following proven andragogic methods which, in turn, will help these students who are living with mental illness to make better progress toward increasing literacies (especially in math and science), identity transformation, and community integration. If andragogic and transformative learning principles were used to train staff and volunteers, they would also be more able to help their students. Currently, they are effective at emotional and social support for students but not as effective in their educational support. With more andragogic training they would be focused on a tested set of practices and transformative learning goals that will guide their practice and address the staff coordination issues that were identified in the results.

However, given the relatively low level of success among students in attaining their educational goals and a self-identified lack of confidence among some staff and volunteers in their ability to teach the necessary skills and subject matter, we identified a need for staff members and volunteers to have training in adult teaching strategies, curriculum, and resources suitable for adult learners. Andragogy, or adult education pedagogy, is designed to specifically support adult learners and involves different teaching techniques than those used for children (Pratt, 1988). Knowles (1980) described five assumptions that formed the basis of the current understanding of andragogy:

[T]he adult learner [is] someone who (1) has an independent self-concept and who can direct his or her own learning; (2) has accumulated a reservoir of life experiences that is a rich resource for learning; (3) has learning needs closely related to changing social roles; (4) is problem-centered and interested in immediate application of knowledge; and (5) is motivated to learn by internal rather than external factors (cited in Merriam, 2001, p. 5).

From this foundation, andragogy has evolved to a point where a well-planned educational environment for adults is one with books and resources that are appropriate for adults, where students are part of an equal relationship with the teachers, and where adult learners are not only supported, but also accepted and respected (Best, Still, & Cameron, 2008; Merriam, 2001; Mezirow, 2012). SEd programs must be similar to community-based adult education programs in this respect. For adult learners who live with mental illness, a sense of acceptance and respect is needed; otherwise, the persistence and success of the students will be hampered.

For instructors and volunteers in SEd programs to be most effective, PD that mirrors good andragogic principles is needed. PD should be an opportunity for support, growth, community building, and development for professionals (Beavers, 2009; Boud & Hager, 2012; Cranton & King, 2003). Adult educators need regular PD opportunities specific to andragogy to stay up-to-date on ideas about curriculum, teaching strategies, and technology and would also increase the organization of the program as it would have more focus. The ability to use and teach technology skills is particularly important because it is one of the most valuable literacies for students to acquire. We see PD in the SEd setting as arising from the needs and concerns voiced by the staff in the program. When the staff determines the kind of training they would most benefit from, they are invested in the process. Only when there is motivation to change will there be investment, and only when there is investment will an enhanced pedagogy be the result of any PD initiative.

Discussion of staff results: Transformative learning as effective SEd practice

We have demonstrated the value of student transformative learning in SEd but transformative learning by educators is also valuable. Transformative learning allows teachers to co-create knowledge with students. For example, teachers can learn new technologies even as they are teaching students about them; indeed, technologies are often best mastered through hands-on teaching and learning. By doing so, teachers can develop a critical understanding of the needs of each learning situation. There is a need to understand learners through the lens of changing societal norms, technology, and the political and economic contexts.

Thus, educators need to question both the nature of education and knowledge, as well as what the uses of such knowledge might be for adult learners. This involves an interpretation of their experience to move forward with the incorporation of that experience into a critical framework. In advocating for PD for adult educators, Cranton and King (2003) talk of the importance of intentional reflection about the content, process, and premise of teaching practice. This is about questioning assumptions and discovering how instrumental knowledge fits into one’s own experience, in order to create an authentic self as an educator. When PD occurs in this way, it becomes transformative. For PD to be transformative, those who design and provide PD programs need to clearly consider and articulate the purpose and benefits for adult educators (Beavers, 2009). In doing so, it values individuality, but still allows for reflections and questioning of practice and experience to help facilitate transformational student learning experiences. As Cranton and King (2003) contend, transformative learning should be one of the main PD goals for adult educators and, therefore, must include: (1) self-reflective critical thinking that questions assumptions and understandings; and (2) empowerment and equity as goals of andragogy.

Transformation theory also sees teachers as learners (Beavers, 2009) who can use their lived experience to create authentic and inclusive learning environments and empower students. The transformative nature of adult education builds on Paolo Freire’s (1976) belief that adult education helps people understand the structures that oppress them. Today, the idea of transformational learning is tied to lifelong learning, particularly in the sense that information is not static and one needs to constantly develop one’s understanding of new processes and structures. Therefore, adult education can be seen as a building block of community development (Brown & Hannis, 2012). Lifelong learning is more than just ongoing education; it is about increasing one’s personal development, transforming one’s participation in social, economic and cultural development, and developing community knowledge to enable civic participation (Brown & Hannis, 2012). At the same time, lifelong or transformational learning is also about improving or upgrading skills and improving one’s technical or professional qualifications (Grace, 2013; Mezirow, 1997). At this instrumental level, lifelong learning is important for labor market integration (Arbesman & Logsdon, 2011; Soydan, 2004). Indeed, for adults living with mental illness, SEd needs to go beyond simple skill training. Yet, most SEd programs have been designed with the ultimate goal of securing employment (Anthony & Unger, 1991; Gutman, Kerner, Zombek, Dulek, & Ramsey, 2009; Soydan, 2004; Steed, 2014) while only a few SEd programs are tailored to assist students enrolled in vocational certificate courses (such as horticulture and hospitality; Best, Still, & Cameron, 2008; Mowbray et al., 2005). While preparation for integration into the job market is important, we argue that the benefits of SEd to general quality of life and sense of self-determination and autonomy should also be considered.

Instructors who have experienced their own transformation through PD will be better able to support adult learners with psychiatric disabilities in their efforts to become empowered through education for job-related skill acquisition and, perhaps, more importantly, for broad-based literacy skills that allow for improved quality of life (Taylor & Laros, 2014).

Program recommendations: Designing transformative SEd programs

A key component to creating SEd programs that will afford transformative learning among the program’s students is to ensure that instructors have access to transformative PD. Cranton and King (2003) suggest a number of practical strategies to implement transformative PD. These include using: (1) action plans; (2) reflective activities; (3) case studies; (4) curriculum development; and (5) critical theory discussions. Based on an assessment of the program we studied and related research about transformative learning we have detailed earlier we are making a number of recommendations which can be applied to any similar hospital based SEd program. In particular, we believe that through more formal PD which uses reflective activities and critical thinking discussions, instructors will be better able to support their students in accessing and developing the skills that will allow them to become better integrated into their communities and workplaces. The recommended actions involve ongoing PD for staff and volunteers.

Action 1: Provide staff and volunteers with PD in adult educational practice. In order to improve the quality of the program and to ensure the success of the students, we recommend that current and incoming staff and volunteers be trained in adult education curriculum and methods of teaching. Affiliation with a literacy and basic skills (LBS) provincial agency will allow for easier and regular access to adult education training for staff and volunteers. This PD should respect the knowledge of the teachers, while also discussing andragogic best practices, strategies for empowering students and ways to encourage critical thinking. Transformative PD that co-creates knowledge and inspires continued growth as educators should be the goal of future training.

Action 2: Implement adult education protocols and transformative learning goals. SEd programs must be designed around the well-established adult education models in Canada. Since there is well-documented evidence that demonstrates the importance of using age-appropriate education materials for adults, we recommend that the SEd program use materials provided for the provincial standardized LBS program and curriculum. By linking with the provincial LBS program, students will be better able to transition to community-based education once they are discharged from the hospital and return to their home communities.

Action 3: Improve and intensify intake assessments. Robust intake assessments set the framework for a student’s educational program. When students are first referred to the program, we recommend that assessments include a risk assessment, creation of a sensory profile, and a determination of positive and constructive feedback preferences. Questions about their perceived educational barriers, past educational experiences and their personal and professional goals should also be asked by the intake person and this should be the beginning of a critical self-reflection dialogue that continues in the classroom. In addition, students should set productivity objectives that include both short- and long-term goals. Part of this assessment will determine which program the client will undertake (i.e., pursuing high school credits for further education, vocational training, or personal satisfaction or upgrading academic skills for work or greater independence). This would allow staff to develop very specific transformative learning plans that will help students achieve their transformation goals (although these must remain flexible to allow for student growth).

Action 4: Establish a monitor and modify protocol for each student. Establishing a protocol for staff and volunteers will allow for monitoring and modifying individual programs and student goals on a regular basis. Monitoring student progress in traditional settings (secondary and post-secondary institutions) now includes a variety of electronic strategies. Monitoring student progress in adult education, continuing education and SEd settings should now reflect this trend as well since technology can be an important part of transformative learning (Wang & Cranton, 2013). For example, e-portfolios stored on secure hard drives, servers, password protected websites, or even student universal serial bus (USB) storage drives would be a source of great pride for students, and might even be incorporated into resumes for job applications. This incorporates other ideas of transformative learning in which students transform their identities and now their transition from patient to student could potentially become student to worker.

Participant progress can be monitored through the course work completed, grades on assignments and tests, and evaluation of comprehension. Based on these observations, instructors can modify tasks as needed by providing and/or removing additional supports, changing students to a more appropriate course or level of study, and by reviewing progress through success criteria.

Progress can be addressed by what Manthey (2011) describes as “motivational interviewing.” Motivational interviewing is a person-centered guiding method of communication designed to elicit and strengthen a client’s motivation for change and re-connect instructors with students. In the context of SEd, motivational interviewing may be able to help a student who is frustrated by stigma, symptoms, and barriers to reconnect with the intrinsic reasons that motivated them to pursue education in the first place. The three main principles of motivational interviewing are: rolling with resistance and expressing empathy; developing discrepancy and supporting self-efficacy; and eliciting change talk while providing a menu of options. This will help to reconnect student with intrinsic motivations and help them surpass barriers thereby increasing student involvement and motivation and promoting transformative learning.

Conclusion: The transformative context

The psychiatric hospital whose SEd program we assessed used a recovery model of care which was described as one which fosters empowerment, hope, recovery, collaboration, identity, responsibility, and meaning in life. The model was built on a holistic, patient-centered approach and combined medical, rehabilitation, and psychological perspectives in the treatment of mental illness. The shared journey promoted the inclusion and empowerment of patients, as well as treatment options that were tailored to the individual needs of patients to support their well-being. Our interviews demonstrated that many patients at the psychiatric hospital who had experienced mental illness needed considerable help with socialization and learning how to function in educational or work environments in order to help them transition to other identities, such as student or worker. Our discussion identified psycho-education as an essential element of recovery for these students with mental health conditions. We also discussed the added benefit of participation in this type of adult education which was that the psycho-education provided a structure which was important for students’ day-to-day functioning, especially for those who were living outside the hospital setting. In addition, our results showed it helped with the independence and confidence of students. In order to build on those positive outcomes, we have recommended that there needed to be more transparency regarding assessments of progress; when individuals are more aware of their day-to-day progress and have input, they would feel more included in their educational experience and become empowered through transformative andragogic practice. Well-designed SEd programs that include andragogic principles can lead to better jobs and improved community and social integration (Brown & Hannis, 2012; Gutman, 2008; Gutman et al., 2009; Koblik, Kidd, Goldberg, & Losier, 2009) which is why we presented them with recommendations, a summary of which we reproduced in the current article, to further improve their program and build on their psycho-educational strengths.

Our findings reflected those of other researchers who found that adult learners who are more self-directed are better able to gain control over their lives because they developed perseverance, self-discipline, and self-confidence (see for example, Corrigan et al., 2008; Mousavi, Forwell, Dharamsi, & Dean, 2015). Our research extended and reinforced this finding in its focus on the impact of SEd on adults living with mental illness. The findings of our case study also indicated that an informal style of programming worked adequately when there was low enrollment and few staff in the program. We argued, however, that programs can become more successful by implementing well-tested methods of adult education pedagogy and using formalized adult education curricula based in transformative learning in addition to the psycho-education and supports traditionally provided by occupational therapists. Furthermore, we recommended seeking and ensuring sufficient funding that would allow for greater access to appropriate resources and personnel for SEd programs, as well as providing access to critical PD in andragogy for program personnel. Lack of adequate funding often undermines the strength of SEd programs (see for example, Gilbert, Heximer, Jaxon, & Bellamy, 2004). Similarly, finding staff who are trained in adult education as well as in the mental health field is particularly challenging. We recommended both types of staff because they are needed for the program to be successful and grow. We also recommended this hiring be supplemented with critical PD that would allow for regular staff reflection and re-assessment of their andragogy and the goals of transformative learning.

We have shown that transformation theory offers ways to create richer and more flexible SEd programs that address equity and individuation concerns through the conceptualization of education as empowering and transformative in nature. Adult education students, particularly those living with mental illness such as the ones we studied, were seeking transformation and something beyond traditional educational practice. We recommended providing this type of non-traditional practice as we predicted it would yield better educational and quality of life outcomes.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Social Science and Humanities Research Council of Canada Insight Development Grant (430-2013-0044).