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 longitudinality of community-based psychosocial rehabilitation services were related to superior functional outcomes for individuals diagnosed with schizophrenia. The purpose of this study was to assess the degree to which the intensity and longitudinality of services were related to improvements in subjective experience and clinical outcomes, and to examine the relationships among prospective changes in functional, clinical, and subjective experience variables. 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 outcome data were gathered every 6 months over a 3-year period. Data were analyzed using hierarchical linear modeling (HLM) and P-technique factor analysis. The results indicated that (1) greater service intensity and the longitudinality of services were associated with improvement in client self-esteem; (2) there was evidence for three distinct factors of prospective rehabilitative change that corresponded to the conceptual domains of clinical, functional, and subjective experience outcomes; and (3) there was no differential program impact on symptom levels or the intrapsychic deficits. In addition, the three-factor model of outcome consisting of functional change, clinical change, and subjective experience change was similar to Strauss and Carpenter'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.