Understanding living skills: first steps to evidence-based practice. Lessons learned from a practice-based journey in the Netherlands.

Living skills training is a commonly used but sparsely described and researched - occupational therapy - intervention for people with severe mental health problems. A service improvement project was established in a mental health organization in the Netherlands starting in 2006 to design more effective living skills training courses for individuals and groups. The steps of the evidence-based practice process underpinned the project. Theoretical and empirical evidence was derived from an extensive literature review. This was supplemented by the preferences of clients and their families as an equally valued source of evidence as is the experience and knowledge of a range of mental health professionals. Information from these three sources provided building blocks for the development of living skills training, resulting in an individual process guideline and two group courses. Implications for practice is that living skills training needs to be part of multidisciplinary treatment and can be best provided in the client's natural context. Limitations of this study are the lack of an evaluation of both the group courses and of the individual process guideline, also due to the continuous implementation in an ever-changing context. There is further need for research into the clinical and cost effectiveness of living skills training, both for individuals and groups, to support evidence-based decision making and service planning.