Js. Brekke et Jd. Long, Community-based psychosocial rehabilitation and prospective change in functional, clinical, and subjective experience variables in schizophrenia, SCHIZO BULL, 26(3), 2000, pp. 667-680
In a previous study, we found that the intensity, specificity, and longitud
inality of community-based psychosocial rehabilitation services were relate
d to superior functional outcomes For individuals diagnosed with schizophre
nia. The purpose of this study was to assess the degree to which the intens
ity and longitudinality of services were related to improvements in subject
ive experience and clinical outcomes, and to examine the relationships amon
g prospective changes in functional, clinical, and subjective experience va
riables. One hundred seventy-two individuals diagnosed with a schizophrenia
spectrum disorder were followed for 36 months in three distinct models of
community-based care. Functional, clinical, and subjective experience outco
me data were gathered every 6 months over a 3-year period. Data were analyz
ed using hierarchical linear modeling (HLM) and P-technique factor analysis
. The results indicated that (1) greater service intensity and the longitud
inality of services were associated with improvement in client self-esteem;
(2) there was evidence for three distinct factors of prospective rehabilit
ative change that corresponded to the conceptual domains of clinical, funct
ional, and subjective experience outcomes; and (3) there was no differentia
l program impact on symptom levels or the intrapsychic deficits. In additio
n, the three-factor model of outcome consisting of functional change, clini
cal change, and subjective experience change was similar to Strauss and Car
penter's "open-linked" system of outcome in schizophrenia. The implications
of these findings for research and practice in the area of community-based
rehabilitation for individuals with schizophrenia are discussed.