Community-based psychosocial rehabilitation and prospective change in functional, clinical, and subjective experience variables in schizophrenia

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.