The purpose of the research is to determine the effects of implementing a program of intensive community-based services with treatment resistant, seriously mentally ill (SMI) individuals designed to improve their social, independent living, and problem solving skills. These intensive services will be delivered by means of highly structured """"""""modules"""""""" that teach individuals functional living skills such as self-management of psychotropic medication, care of personal hygiene, and fulfillment of recreation and socialization needs. Each module consists of seven thoroughly specified """"""""learning activities"""""""" that explain and demonstrate the skills to be learned, require that they be practiced within the training environment, teach methods of solving problems that might arise when the skills are used outside of the training environment, and have the skills actually practiced in the """"""""real world."""""""" In conjunction with the Ventura County (CA) Department of Mental Health, the effects of the module services will be evaluated with a randomized control services design. A total of 80 treatment resistant, SMI individuals will participate in the project, with 40 randomly assigned to the module services and 40 assigned to equally intensive control services, both of which will be conducted by project personnel. Individuals will participate in cohorts of 16 (5 cohorts total) for 30 months; 6 months of intensive services plus 24 months of booster sessions and follow up. In addition to meeting inclusion criteria for age, diagnosis, chronicity, need for and capability to benefit from training, each cohort of 16 individuals will be randomly selected from a list of 80 individuals whose psychiatric services during the previous 6 months have been the most costly. The effects of the services will be determined with measures of individuals' symptoms, rates of relapse and rehospitalization, use of services, instrumental role functioning, quality of life, and burden to significant others.
