[Upbeat music plays as Natalie, a CAT therapist, gets out of her car. She’s carrying various items with her as she walks across the street to knock on the door of a home. A lady answers the door.]
Natalie Hi, Francis! I brought lots of stuff for us today.
Francis Oh, great!
[Natalie enters the home. ]
Natalie Okay, Francis, so like I said, I brought a bunch of stuff for us today.
[The camera pans to a plastic bin, a full plastic bag from Walmart, and a wire shower caddy containing a toothbrush, a tube of toothpaste, shampoo, and conditioner among other things.]
Natalie Do you remember last week when I was here I did that checklist of all the stuff you did and didn’t have in the house?
Francis Yes, right.
Natalie Okay, there were quite a few things that you needed, but we’re going to start with these few critical items today.
[Natalie points to a large wall calendar that she brought with her.]
Natalie We talked about a calendar and how important that is so we’re going to put that up somewhere. You didn’t have a lot of the hygiene supplies that you need like shampoo and soap and things.
Francis No, I didn’t.
Natalie Then most importantly, we’re going to work on medication: maybe organizing it a little better than it is, putting it in a container like I had talked about last week. Okay?
Natalie Is that alright?
Francis Yeah, that’s alright.
Natalie Okay, so you medicines are in your bedroom?
Francis Yes, they’re in my bedroom.
Natalie Okay, why don’t we go in there and we’ll start with the medicines and we’ll come back and get this in a minute, okay?
Francis Okay, sure.
[Natalie picks up the full Walmart bag that she brought with her and she and Francis go in to Francis’ bedroom. The top of Francis’ dresser is covered in with various items including medication bottles, a spray cleaner, Vaseline, and acetone.]
Natalie Okay, Francis. These are all your medicines here, right?
Natalie Last week, you told me that you missed taking your medications sometimes, is that right?
Francis Yes, sometimes I miss taking my medications.
Natalie About how frequently?
Francis About one to two.
Natalie One to two times a week?
Francis A week, yes.
Natalie Okay, so our goal we talked about is taking it all the time, right?
Natalie You’re taking pretty important medicines at night.
Francis Yes, yes I do.
Natalie How often or how many times a day do you take medicine?
Francis In the morning and at night.
Natalie Okay, and are you missing morning doses more or night doses more?
Francis The night doses.
Natalie The night doses are the ones?
Natalie Okay, and why do you think that is?
Natalie Any particular reason?
Natalie Do you forget or fall asleep?
Francis I probably just fall asleep.
Natalie Okay. What time do you normally take the morning medicine?
Francis Like around 9.
Natalie Okay, 9 o’clock. Is that when you get up?
Natalie Okay, and what time are you supposed to take the night medication or what time do you like to take it?
Francis Like at 8 o’clock or so.
Natalie 8PM, okay. Is that about when you go to bed as well?
Natalie Okay. Right now I see that you have a lot of medicines in bottles here that haven’t been unpacked. Is this normally where you keep your medicine?
Natalie Okay. I’m wondering if you think— I see some hiding over here.
[Natalie picks up a medication bottle.]
Natalie Is this a current one?
Francis Yes, ma’am.
Natalie This is a current one too, okay. I’m wondering if you think we could organize it a little bit better or in a better place so that you don’t forget to take it.
Francis Sounds like a great idea.
Natalie Would that be okay?
Francis Yeah, that really helps a lot.
Natalie Okay. I saw that you have a little nightstand here.
[The camera pans to a nightstand next to the bed. On the nightstand is a spray bottle, an alarm clock/radio, a case for eyeglasses, and a piece of mail.]
Natalie And you said that you’re missing your night medication. Would it be safe if we put the medicine there? If we set up the medication container there?
Francis Yeah, that’d be great.
Natalie No kids around or anything that would open it up?
Natalie Okay, and do you think that would help remind you before you go to bed to take the medicine if it was right there, really close to you?
Francis Yes, it would help a lot.
Natalie That would work? Okay, well I brought a medication container and I want you to look at it and see if this is going to be okay.
[Natalie takes a medication container out of the bag and shows it to Francis. There are two rows on the container: one row is purple and the other row is blue.]
Natalie The purpose of this one is to keep your AM and your PM medication organized and all in the same spot. So instead of having it in two different containers, we’re going to put it in one just to keep it all together. Does that make sense?
Natalie And that’s okay with you?
Francis Yes, that’s okay. I like that.
Natalie Okay, good, I’m glad! So the AM medication is this kind of lavender color and the PM is blue. It kind of reminds me of evening, so hopefully that will help you. Why don’t we take all the medicines you have.
[Natalie points to a package of medication.]
Natalie Are you supposed to be taking these right now?
Francis Not right now.
Natalie Okay. Just these three?
Francis Just these three.
Natalie These are your morning and your evening?
Natalie Okay, why don’t we take these and sit down and I can help you fill you fill out his container.
[The screen fades out to black. Once the screen fades back in, Natalie and Francis are sitting down and have the medication container and Francis’ pill bottles between them.]
Natalie You know, another thing I was thinking about that you mentioned last week, Francis, is that you weren’t sure if your medications were working very well because you were still having some voices.
Francis Some voices, yeah.
Natalie You know, one of the things I was wondering is if you were, well, you just said you were missing a couple of doses every week, right?
Natalie And that’s the medication that would probably help the most with the voices?
Natalie So, it might be that if you take them every day, that the voices do get better.
Natalie Does that make sense?
Francis Yes, it makes sense.
Natalie So then you’d be able to talk to your doctor about—
Francis The symptoms I’ve been having and the voices that I have problems with or something.
Natalie Right, and you can say, if you have been taking your medicines every day, then you can tell them—
Francis I can know the difference if I’m right or wrong.
Natalie Yeah. That’s also a good idea for doing this, I think. So I’m going to go ahead and give these to you and then I’m just going to kind of watch you fill this up and put the pills in.
[Natalie hands the medicine bottles to Francis who takes them to fill the container with.]
Natalie Let’s see. Do you understand how this works? Let’s open all these up for you. So remember, this is the AM over here, the morning. You said your 9AM dose?
Natalie Okay, and do you know how to do this?
[Francis begins putting pills into the container.]
Natalie That’s for PM? Okay.
[Francis begins putting one pill from the bottle she’s holding into each of the PM compartments of the pill container. However, she misses one of the compartments.]
Natalie Did you mean to miss that day or was that an accident?
Francis Oh, that was, um, I think that was an accident.
Natalie Okay, go ahead and put one in there. Okay, let me just check the bottle real fast.
[Francis hands Natalie the bottle and Natalie reads the label.]
Natalie This actually says twice a day, right?
Natalie So why don’t we go ahead, while you have the bottle, and just fill up the morning ones as well.
[Francis takes the bottle back and puts one pill in each of the AM compartments.]
Natalie Are you normally in charge of all your own medication?
Natalie One slipped out there if you want to put it back in. So no one helps you, reminds you?
Francis No, I take the medications myself.
[Natalie takes the completed bottle from Francis and hands her another pill bottle.]
Natalie Okay. Do you want to do the next one?
[The screen fades out to black. When the screen fades in again, Natalie and Francis are in Francis’ bedroom standing by the bed and nightstand. Francis is holding the three pill bottles she just used to fill up her new pill container while Natalie is holding the newly filled pill container.]
Natalie Okay, so you said this was an okay spot to put your medication, right?
Francis Yes, my nightstand is a very good place to put my medications right there.
Natalie Close to where you take them at, right?
Natalie Okay. There’s some stuff on here right now. We want to leave the alarm. That’s your alarm, right?
Natalie We’re going to work with that, maybe in a minute. What about this letter?
Francis No, I’m going to move this out of the way.
[Francis removes the letter from her nightstand.]
Natalie Okay, and is that okay?
Natalie Okay, maybe we can organize some of that later. Okay, so we’re going to put this here.
[Natalie places the new pill container on the nightstand and gestures toward the pill bottles that Francis is holding. The bottles still have medication in them.]
Natalie Now, your extra medication, what we don’t want to do is having you take it from the bottles and from the medication container. The reason for the medication container is to see if you’ve taken it already that day.
Natalie So what would be a good place to store those bottles and maybe those extra bottles that you’re not using?
[Francis opens the top leftmost drawer of a dresser and removes a plastic bag.]
Francis I have, in the drawer, I have a bag here. I can put them in here.
Natalie; Okay, and you can remember that you put them in there?
Natalie Okay, alright. It looks like you have a few other bottles of medications in there as well. Are those older medicines that you don’t need anymore?
Francis Yes, older medicines I don’t need anymore.
[After putting the pill bottles she was holding into the plastic bag, Francis begins to put the bag back in the drawer.]
[Natalie points toward some pill bottles on the dresser.]
Natalie Okay, and maybe the extra ones that you have there that you haven’t started?
[Francis puts the extra pill bottles into the plastic bag as well before putting the bag into the drawer.]
Natalie Okay, so maybe we’ll organize some of those other medications and maybe go through them at some point in time and see what you need.
Natalie Are you hanging on to them for any reason?
Francis No, I just have them there.
Natalie Are they pretty old? Expired? Or are you not sure?
Francis I’m not sure.
Natalie Not sure? Okay, well we’ll go through those in a little bit. So you said you take your medicine at 9AM and 8PM?
Francis 9AM, right.
Natalie Okay, you’re mostly forgetting your PM medication.
Natalie What if we set an alarm for 8PM?
Francis That sounds good.
Natalie That sounds good?
Natalie You have your alarm here. I know that you also mentioned using your cell phone as an alarm last week.
Natalie Which would you prefer for your 8PM medication?
Francis The alarm clock.
Natalie You want to set this one? Okay, we’ll set this one- let’s see here – for 8PM.
[Natalie begins setting the alarm clock on the nightstand for 8PM.]
Natalie And it looks like it just has the one alarm on here now. Okay, so we’re going to go with this now, and then if we need to set another alarm for the AM medication, we’ll add that in later. Right now, it seems like you’ve been taking that every day, okay?
Francis Okay, right.
Natalie And we’re going to turn this on to start for tomorrow. Okay?
Natalie Alright. Another thing that I haven’t talked to you about yet but that I wanted to ask if it was okay—sometimes, I found that people don’t take their medicine when they keep it in their bedroom because they don’t have anything to drink.
[Natalie picks up the plastic Walmart bag she brought here with her and removes two small water bottles from it.]
Natalie So I was wondering if we set up some bottles here, maybe underneath here and one on top, if that wouldn’t make it even easier to take your medicine when you’re in bed in the morning and in the evening. Does that sound good?
Francis Yeah, that sounds great.
Natalie Okay, so I’m just going to put one up here on top and I’m going to leave a few below for when you run out, okay?
Francis Right, great.
[Natalie places one bottle of water on top of the night stand and then places a few more bottles of water on a small shelf of the nightstand that sits just above the floor.]
Natalie Okay, so it looks like you’re set for tomorrow.
Natalie Actually, tonight will be the first test.
Francis Tonight, yes.
Natalie Okay, and which one are you going to take it out of tonight, Francis?
[Francis picks up the pill container and pops open the blue lid with the label “Thursday.”]
Francis Tonight is Thursday.
Natalie Thursday PM, right. And tomorrow morning, which one will you take?
Francis Friday morning.
Natalie Friday AM, good. Go ahead and put that back down.
[Natalie takes a brightly colored, laminated piece of paper out of the plastic bag and shows it to Francis.]
Natalie I also brought a sign that says, “Don’t forget to take your medicine.” Do you think that would be helpful for you or do you want to try just the alarm first?
Francis The sign would help a lot.
Natalie You think the sign as well? Okay, maybe this will help with the morning one. Where do you think you want to put it?
[Francis gestures to the mirror above the dresser that is next to her bed.]
Francis Right here on the mirror.
Natalie You want to put it on the mirror? Okay, let’s get some tape then.
[They get some tape and are standing in front of the mirror. Hanging from the top of the mirror is a floral wreath, and on the dresser is a large porcelain doll, Vaseline, and many other miscellaneous items.]
Natalie So you mentioned putting it over here on the mirror. Do you think you’ll be able to see it from there?
Francis No, probably around on this side right here.
Natalie Why don’t you pick a spot?
[Francis takes the sign to a spot on the left-hand side of the mirror.]
Francis Right here.
[Natalie is holding the tape.]
Natalie And is this type of tape okay?
Francis Yeah, that’s fine.
Natalie You sure? Okay, let’s do this double-sided like this. Is that going to hurt the wood at all?
Francis and Natalie begin taping the sign to the mirror in the spot Francis chose.
Natalie Okay, there’s one. Let’s see, and we’ll do one more at the bottom. And so what we’re doing here is just testing this out. We’re going to see if the alarm works, if the sign works. If it doesn’t, we can always change it up next week. If you get to where you take them every single day and you don’t want the sign anymore, then we’ll just take the sign down or if it’s not working, we might use a different color sign next time, okay?
Francis Okay, that sounds great.
Natalie Alright, anything else then for your medications?
Francis No, that’s it.
Natalie You’re all set.
Francis I’m set.
Natalie Okay, then we brought some other things for today.
Natalie We brought some hygiene stuff and a calendar. You said you share your bathroom, right? With a roommate?
Natalie Okay. Where do you want to keep—
Francis The calendar?
Natalie Well, we are going to talk about the calendar, but where do you want to keep your hygiene supplies? Do you want to keep them in your bedroom or in the bathroom? I’m not sure if you and your roommate share things.
Francis In my bedroom.
Natalie You want to keep the hygiene stuff in here?
Francis In my bedroom.
Natalie Okay, I brought a little caddy, if you saw that. It’s called a shower caddy.
Francis Oh, wow, that’s cool.
Natalie And so that’s easy to take it in there with you every time.
Francis To carry it around, yeah. Yes, that’s very helpful.
Natalie It’s very cluttered up here. Where do you think would be a good space to keep your hygiene stuff?
[Francis motions to the top of the dresser.]
Francis Um, I’ve got to make some room right here.
Natalie You think you want it out on the counter? Yeah, if we put it away, sometimes we forget about it.
Francis Yeah, I’ll probably forget it.
Natalie Okay, well why don’t we clear a space here. We can talk about where some of these things can go then.
[The screen fades to black. When the camera fades back in, the top of the dresser has been cleared off, and Natalie is placing the shower caddy with the hygiene supplies on the dresser.]
Natalie These are the hygiene products that you were out of. It sounds like you were using some of your roommate’s stuff and that was causing some friction.
Francis Yes, right.
[One by one, Natalie begins taking the items out of the caddy, talking to Francis about them, and then returning them to the caddy.]
Natalie The first one is the body wash. What do you use this for?
Francis For my body.
Natalie Whole body, right? And how often do you think you should use that?
Francis Every day.
Natalie Every day, okay. That’s going to be the goal?
Natalie Okay. It looks like you have some deodorant. Are you out of deodorant?
Francis Yeah, I am out of deodorant.
Natalie Is that one empty?
Francis Yeah, this one is empty.
Natalie Okay, we’ll throw that one out on the way out. Okay, so here’s some new deodorant. And how often do you think you should be putting on deodorant?
Francis Every day.
Natalie Every day, okay. Toothpaste. Let’s take this out of the box. There’s no reason to keep the box right now, huh? And how often do you think you should probably brush your teeth?
Francis Every day.
Natalie Every day. Once a day, twice a day, what’s the goal?
Francis Twice a day.
Natalie Twice a day is the goal?
Francis Twice a day.
Natalie That’s pretty ambitious. I know before it was just a few times a week, right?
Francis A few times a week, yeah.
Natalie Alright, toothbrush. I know you had one but it was pretty old. It seemed like it was a couple of years old so I got you a new one.
[Natalie removes the toothbrush from its packaging and sets the packaging aside.]
Natalie Okay, let’s throw these things out when I leave. This is a scrubbie, and do you know what this is used for?
Francis My body, when I take a bath, like a sponge.
Natalie And what do you put on here?
Francis Soap, bodywash.
Natalie Okay, good, good. The other thing I brought – and this is going to be up to you whether you want to use it – is a checklist for your daily activities that we’ve been talking about. You talked about going from taking a shower once or twice a week to—
Francis Every day.
Natalie Every day. That’s really ambitious and I applaud that. What I would like to do is just this first week, just check off what you do.
[Natalie shows Francis the daily activity checklist which is a table with days off the week along one axis and daily activities along the other.]
Natalie So the first one is taking your morning medication and you’ve been doing really well on that anyway.
Natalie The next one is taking a shower. Again, you’re just going to check off when you do it. If you don’t do it, that’s fine. We’ll work on that.
Natalie Brushing your teeth. If you do it twice a day, you’re welcome to check it off twice. I know you’ve only been doing it a few times a week right now, so just check it off when you do it.
Natalie Washing the dishes. The reason I put that on there is because you had said that that is your chore that you’re supposed to be doing but you haven’t really being doing it that often so I put that on there.
Francis Right, yes.
Natalie Again, just if you do it. Then, taking your evening medication. The reason we do this is just to keep track, kind of like the medication container. We’re keeping track of what doses you’re taking. On this one, we’re keeping track of which activities you’re doing each day.
Natalie We’ll look at this next week when I come back, and I’ll bring a new one for the following week, and then we’ll keep working on that, okay?
Francis Sounds great.
Natalie Francis, I’m wondering where you’d want to hang this? Ideally, we’d want to hang it up in a place where you can check it off. I know you’ve got a lot of stuff on your walls in here. Where do you think?
[Francis takes the list and walks over to the wall by her bed and removes a card from the wall.]
Francis Right here. I’ll just take this off.
Natalie You want to take the card off?
Natalie Are you sure?
Francis Yes. I’ll just put it right here.
Natalie Alright, well let’s get the tape again and we’ll put it right there.
[ The camera fades to black and when it fades back in, the checklist has been taped to the wall.]
Natalie Does that work?
Natalie Now the only thing we’re missing is a pen, and I brought some markers. Do you want to grab that marker? And what we’ll do is I have some string in that little kit there.
[Natalie points to a screw in the wall near the checklist.]
Natalie I don’t know what the screw here is for. Is it okay if we tie a little string to it?
Natalie And then we can tie a string to the pen? That way, you don’t have to look for a pen anywhere.
Francis Yeah, and just check it off.
Natalie Would that work?
Natalie Okay, so let’s do that then.
[The camera fades to black and when it fades back in, Francis is looping a piece of string around the screw in the wall. On the end of the string is a marker that she can use for the checklist.
Francis Sounds great. That’s a good idea.
Natalie What have you done today so far? Did you take your medication this morning?
Francis Yes, I did.
Natalie Okay, why don’t you go ahead and mark it off?
Francis Right here?
[Francis puts a checkmark in the appropriate box.]
Natalie It’s Thursday. Have you taken a shower yet today?
[Francis puts a checkmark in the appropriate box.]
Natalie You took one for the visit? Okay. Have you brushed your teeth yet today?
Natalie Okay, so just check off only what you do each day and we’ll take a look at it next week.
Natalie Alright. Okay, we have one more thing for today. I know it’s been a long visit. We have a calendar. I brought one. Now, I didn’t see that you had one last week when I was here, but it looks like it’s on May. Do you use it very much?
Francis Not that often, no, not that much.
Natalie Okay, and it’s also really hard to get to right now. The reason we use calendars is to kind of keep track of our appointments like appointments with me, appointments at the clinic – I know you have to go in pretty often – and keep track of some other things that you have to do.
Natalie What do you think about using this calendar that I brought? The bigger calendar?
Francis I think that would be very helpful because it’s really big so you can see the numbers and all that and I can just write down my appointments and where I need to go and all that.
Natalie Okay, so that’s okay?
Natalie Where do you think – it’s nice, again, to be able to write on it and be in a location where you can actually use it. Where do you think would be a good spot and easy for you to write on and keep up with your appointments?
Francis Right there on the wall right there.
Natalie On the door?
[Francis picks up the calendar and she and Natalie walk to the spot Francis was referring to. It is the back of a closed door. There are a few long strips of painter’s tape hanging from the door.]
Natalie Alright, so you think this is the best spot?
Francis Yes, it’s the best spot.
Natalie Do you not use this door?
Francis No, it’s just there.
Natalie Okay, so kind of at eye level wherever you think it would work best.
Francis Like this?
Natalie Yeah, and it’s already got the sticky stuff so just go ahead and push down.
[Francis presses the calendar onto the wall.]
Natalie Excellent. Okay, so what month are we in?
Natalie Right, so why don’t we pull off the days. This takes you all the way through this year.
[The camera fades to black then fades in to the calendar showing the month of August. There is a marker hanging from a string which is secured to the top of the calendar.]
Natalie Do you have any appointments coming up that you know of?
Francis Not that I know of.
Natalie Do you have one at the center coming up?
Francis Yeah, I think so. I don’t know.
Natalie How are you going to figure out when that appointment is?
Francis I have to find my card.
Natalie Oh, you got an appointment card?
Francis Yeah, they gave me an appointment card.
Natalie Okay, where do you think that might be?
Francis Over here? Oh, right here.
Natalie Oh, that was quick. Okay, when is your appointment?
Francis On the 15th.
Natalie Okay, so that’s just next week then.
Natalie Okay, so why don’t you write it on your calendar then?
[Francis walks to the calendar and uncaps the marker.]
Natalie So you want to put your doctor. Do you know your doctor’s name?
Francis Dr. Mercado.
[Francis writes her doctor’s name on the calendar in the box for August 15th.]
Natalie Okay. What time is your appointment?
Francis At 10 o’clock.
[Francis finishes up writing the appointment on her calendar by adding the time.]
Natalie Okay, and I’m also going to come back on the same day next week so why don’t you write my name, Natalie, in there?
[Natalie points to the date on the calendar. Francis writes Natalie’s name down on the calendar.]
Natalie I got here about 1 o’clock today. Is that okay for next week?
Francis Yes, that’s okay. I’ll write that.
Natalie So we’ll probably make that our regular time so we can stay consistent, okay? And Francis, why don’t I have you write my number up there in case you need me?
Natalie Why don’t you write it up here somewhere?
[Natalie points to the top of the page and Francis writes Natalie’s number down.]
Francis Okay, sounds great.
Natalie And you can have that in case you need me in the next week before I come back.
Natalie Alright. Anything else that you have coming up? Any other appointments?
Francis No, that’s all I can think of at the moment.
Natalie Okay. Alright, go ahead and put your pen cap back on. So this is the same thing we did over there with your checklist. We want to the pen to be close to the calendar so we’re never looking for one.
Natalie Alright, very good. Well, we’ve done a lot today.
Francis Yeah, we sure did.
Natalie We’ve done hygiene stuff, we’ve done a lot of medication stuff, we’ve done the calendar. Do you have any questions about anything we’ve done today?
Francis No, no questions at all. It’s very helpful. It helps a lot.
Natalie So next week when I come back, we’ll review the medication container and see how many days are missing. We’ll review the checklist that we did and see how that went, and then you’ll have already been to your doctor by the time I see you next week so I can ask you how that went.
Francis Right, sounds great.
Natalie Okay, anything else? I have a few other items that I’m going to bring you next week. You were missing a hamper and a few other things and so I’ll bring you a couple of new items next week as well and we’ll go over those.
Francis Okay, that sounds great.
Natalie Alright, thank you so much.
Francis Thank you.
[Music starts to play as the credits roll: Executive Producers: Dawn I. Velligan, PhD Natalie Maples Aguilar, MS Director/Editor: Robert Merrill Camera Operation: Lester Rosebrock The UT Health Science Center at San Antonio Department of Psychiatry Division of Schizophrenia and Related Disorders]