This application is a resubmission of a competitive renewal for a Research Scientist Development Award, Level 2 (KO2 00842). It requests 5 years of salary support for the Principal Investigator to continue to pursue mental health services research on a full-time basis and to continue to develop as a researcher. This proposed work would be an extension of a research program developed over the past 15 years to assess the effectiveness of psychiatric rehabilitation programs for adults with serious and persistent mental illness. In terms of substantive focus, this work has concentrated on two main areas: vocational rehabilitation approaches and the assertive community treatment approach. Recent research suggests that supported employment and related approaches, unlike traditional vocational strategies, offer great promise in assisting persons with serious mental illness to work competitively. A major research agenda for the mental health services field over the next decade is to evaluate these emerging vocational approaches and their implications for psychiatric services in general. A focus on employment is a major departure for current mental health systems that typically emphasize day treatment and/or case management services. Employment provides normal adult roles as an alternative to the disabled mental patient identity, and it may activate other changes in identity, morale, and quality of life. Preliminary studies suggest that employment programs can be financed through downsizing day treatment programs without negatively impacting client functioning. Over the next five years, the applicant plans on concentrating on the vocational area. The goals of the research program are: (1) to identify which approaches are most effective, and which are most cost-effective, (2) to identify essential components of effective approaches, (3) to identify client characteristics that predict outcome with specific vocational models, and (4) to synthesize the vocational literature within the psychiatric rehabilitation field. The research plan includes a series of collaborative research projects, including 3 currently funded projects. A variety of program models will be examined, including supported employment, transitional employment, technical training, and consumer-run alternatives. One controlled study is in progress, with pending grants for two additional controlled studies and one quasi-experimental study. Several studies examining fidelity of program implementation are also in progress. The implications of these studies and the emerging psychiatric rehabilitation paradigms will be used to inform mental health policy, with profound changes in the organization and financing of mental health services expected during the remainder of this century.
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