Intensity and continuity of services and functional outcomes in the rehabilitation of persons with schizophrenia

Objective: The intensity and continuity of services delivered to individual clients in a community-based psychosocial rehabilitation program were exam ined in relationship to functional changes in the clients that occurred dur ing the first 12 months of the program. Methods: Subjects were 11 clients w ith schizophrenia or schizoaffective disorder who were admitted to an inten sive psychosocial rehabilitation program Measures of clinical and psychosoc ial functioning were derived from client interviews administered at bast li ne and sis and 12 months later. Measures of service intensity and continuit y came from data gathered daily by staff over 12 months. Results: The resul ts supported the hypotheses that greater intensity and longitudinal continu ity of services are related to more client improvement as indicated by redu ced rates of hospitalization and improved psychosocial functioning after bo th six and 12 months. Although clients' symptom levels increased over time, a significant relationship was noted between service intensity and continu ity and better symptom outcomes after 12 months. Multiple regression analys es indicated that an average of 22 percent, and as much as 28 percent, of t he change in clinical and functional outcomes after 12 months of rehabilita tion was explained by the intensity and longitudinal continuity of services . Conclusions: Clients who received more contact hours with staff and who h ad fewer gaps in service delivery achieved greater rehabilitative improveme nt in social, work, anti independent-living domains and had fewer days of h ospitalization. Based on these findings, clinicians, administrators, and re searchers can assume that the intensity and longitudinal continuity of serv ices are important to achieving rehabilitative outcomes in some community-b ased psychosocial rehabilitation models.