Making something out of paper clips is an activity that people like to do in ACL 4.0. To make a chain long enough to wear, the person must be aware of making a bracelet or necklace as a goal.

Carabiners are new to some people. If so, within ACL 4.0, they can be used to test new learning that is a reasonable expectation because the cues are visible.

(The plastic loops are easier to use than the carabiner. The plastic strip is threaded through holes, such as the circles formed by pony tail holders. Attention is directed towards threading the hole, which is similar to putting a needle through a hole when stitching in the ACLS-6.)

Beads can be strung in seasonal colours. Wearing something seasonal seems to make them feel like they are a part of the flow of community events.

Stamps, stickers, and cookie cutters for salt dough; all come in inexpensive, seasonal themes and can be applied to office paper to make notecards. Notecards are a good way to keep in touch with family / friends and their names and addresses can be kept in the visitors' books left on their bedside table.

Posters for the seasons and holidays can be made if someone will draw a big, traditional shape, such as a 6 foot (1.8 m) Christmas tree on a huge piece of white paper. Give people access to pieces of green tissue paper. They can crinkle the paper and stick it on with rubber cement during the first session. During the next session they can stick on the ornaments, which are different colours of tissue paper.

It will take some planning ahead for them to have access to the top and bottom of the poster. Try stapling the folded top to a dowel that can be raised or lowered.

The concept of trash enters the scale in ACL 4.4. Within ACL 4.0, someone else will need to provide cues to clean up. Without direction, the trash is often left where it is. When living alone, the tendency to not remove the trash often becomes a health hazard.

Sensory information may be used to capture a person's attention if they are anxious. Pleasant and calming sensory information may be used by the person to modulate their anxiety.

Memories include recent information about one or two activities that have a high priority for the individual. The manual actions in the steps are usually familiar and probably stored in the person's procedural memory so that they can be done automatically. Memory within ACL 4.0 usually includes an activity done an hour ago, yesterday and last week. Adjustments in their habitual way of doing activities because of physical environment changes are usually remembered.

A section of the public that likes to think of these people as bums also likes to think that being a bigot is smart. Zero tolerance for such bad behaviour seems to be the best policy.

Health care professionals have played into the problem by making checklists of negative behaviours that are realistic problems for these people. The negatives must be balanced with some positives if we are ever going to overcome the attitudes behind poor funding.

The difference between will not and cannot is a slippery concept that is hard to nail down. It takes time, especially if there is an established pattern for blaming the patient for not taking better care of themselves. Realising that the thought of doing better never enters their mind because of a chemical malfunction in the brain is a strange idea at first. Once staff members catch on to the idea, the whole atmosphere on treatment units' change, but it takes a year of consistent, informal education.