This project will evaluate the effects of two vocational rehabilitation models of community support for persons with severe and persistent mental disorders. The experimental model, psychiatric vocational rehabilitation (PVR), has been specifically designed to treat the needs of persons with psychiatric disabilities as they attempt to return to the world of real work after periods of in- and/or out-patient treatment. PVR provides comprehensive services, delivered over an 18-month period following a month-long prevocational phase of campus instruction. The learning experiences in PVR center on the personal and vocational needs of clients. Technologies comprising PVR have been under development in the Center for Psychiatric Rehabilitation at Boston University over the last decade. Elements of PVR (but not the total program) have been subjected to scientific evaluation under the leadership of William Anthony and his colleagues and the results have been reported in research journals. The control condition with which PVR will be compared is standard vocational rehabilitation (SVR) as currently offered persons with psychiatric disabilities through the Massachusetts Rehabilitation Commission. The SVR services are regulated more by agency than by client needs and were developed for rehabilitating physical rather than mental disorders. It is hypothesized that the client-centered PVR approach will produce better vocational results, as well as certain personal home and community-adjustment outcomes, than will SVR. For this study, Department of Mental Health clients will be referred to the Center for Psychiatric Rehabilitation where prevocational screening and baseline performance will be tested and the clients subsequently randomly assigned to either an 18-month long PVR or an SVR condition (72 per group). Effectiveness of the PVR demonstration project will be evaluated by comparing vocational and other indicators of personal, home, and community adjustment, beginning at six months following baseline performance. There will be three waves of samples entering treatment four months apart: Wave I will receive five outcome evaluations; Wave II will have four assessments; and Wave III will also get four. Outcome measures will be collected to test hypotheses and corollaries that PVR is more effective than SVR in both primary vocational effects, as well as in other secondary effects. Process measures will be obtained to rule out alternative explanations for any main effects arising from PVR/SVR independent variable differences and to insure that PVR and SVR constitute unique interventions.
