Despite the growing population of older persons with serious mental illness (SMI) and the public health implications of poor psychosocial functioning (e.g., nursing home placement), few programs of psychosocial rehabilitation have been developed for this group. Several group based programs have been proven effective for younger people with SMI, but these require modification to match the needs of older people, as recognized by NIMH PA (06-422). Older people with SMI need individually based rehabilitation because groups are: 1) not always feasible (e.g., rural areas), 2) not accessible to older people with mobility or transportation problems, 3) not always palatable (e.g., social anxiety, stigma), 3) not matched to the cognitive level of the individual, and 4) not matched to the skills needs of the individual. The goal of this career development award is to provide the applicant with the necessary training to become an independent mental health services researcher focusing on developing and evaluating individually based programs of rehabilitation aimed at enhancing psychosocial functioning in older people with SMI. Specific career goals are to: 1) learn to incorporate preferences and needs of older consumers into treatment, 2) learn techniques for individualizing psychosocial rehabilitation, 3) enhance expertise in standardizing rehabilitation programs, and 4) develop advanced expertise in study design, methods, and statistical analysis. To achieve these goals, the training plan includes coursework and mentorship from prominent experts in the fields of geriatric psychiatry, psychosocial rehabilitation, statistics, and research methodology. The training plan is complemented by the development of an innovative program to enhance psychosocial functioning in older people with SMI consisting of: 1) a Basic Course in Community Living Skills to establish competency in core living skills, 2) clinician evaluation and a collaborative process to identify skills to enhance through skills training, and 3) facilitation and support of rehabilitation goals in the community. Following a feasibility trial, potential effectiveness will be evaluated in a randomized pilot trial including 60 people age 50+ with SMI comparing this program (n=30) with usual care (n=30). Specific hypotheses of the study are that the intervention, compared to usual care, will result in greater improvements in proximal measures of skills targeted by the intervention and greater improvement in a distal measure of community functioning.
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