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 examined in relationship to functional changes in the clients that occurred during the first 12 months of the program.


METHODS
Subjects were 41 clients with schizophrenia or schizoaffective disorder who were admitted to an intensive psychosocial rehabilitation program. Measures of clinical and psychosocial functioning were derived from client interviews administered at baseline and six and 12 months later. Measures of service intensity and continuity came from data gathered daily by staff over 12 months.


RESULTS
The results supported the hypotheses that greater intensity and longitudinal continuity of services are related to more client improvement as indicated by reduced rates of hospitalization and improved psychosocial functioning after both six and 12 months. Although clients' symptom levels increased over time, a significant relationship was noted between service intensity and continuity and better symptom outcomes after 12 months. Multiple regression analyses indicated that an average of 22 percent, and as much as 28 percent, of the change in clinical and functional outcomes after 12 months of rehabilitation was explained by the intensity and longitudinal continuity of services.


CONCLUSIONS
Clients who received more contact hours with staff and who had fewer gaps in service delivery achieved greater rehabilitative improvement in social, work, and independent-living domains and had fewer days of hospitalization. Based on these findings, clinicians, administrators, and researchers can assume that the intensity and longitudinal continuity of services are important to achieving rehabilitative outcomes in some community-based psychosocial rehabilitation models.
Brekke
J S
JS
School of Social Work, University of Southern California, Los Angeles 90089-0411, USA. brekke@usc.edu
Ansel
M
M
Long
J
J
Slade
E
E
Weinstein
M
M
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019090:Case Management / Q000592:standards*; D003156:Community Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D017050:Episode of Care; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D012559:Schizophrenia / Q000188:drug therapy / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
D014150:Antipsychotic Agents