This is a request for an ADAMHA SDAC to investigate the relationship of client outcomes to services delivered to persons with severe mental illness living in the community. The main outcome of interest will be functional status. The investigator will acquire expertise in and apply three research methodologies essential to conducting comprehensive services research: 1) analysis of patient-level longitudinal outcome data; 2) interorganizational assessment (I/O; and 3) cost-effectiveness. The research component will consist of three projects. The first project aims to compare the cost-effectiveness of two models of delivery of vocational rehabilitation (VR) services. One model, Individualized Placement and Support, combines principles of assertive community treatment and supported employment N=150). The other model is a best practices control condition in which VR is provided by local vendors in a traditional referral model (N=150). These programs will be implemented in a randomized study at Community Connections in Washington, D.C. The second project aims to test the hypotheses that integration of services at the client and/or agency levels result in improved client outcomes. Models which quantify client and agency services integration will be developed by linking client continuity of care measures with agency-level indicators of services integration. Client evaluations (N=661) and 1/O network surveys from the Robert Wood Johnson Program in Chronic Mental Illness (RWJ/PCMI) will provide data for these analyses. The third project will test and cross-validate possible causal models between domains of clinical symptomatology and functional outcome by applying LISREL to the RWJ/PCMI longitudinal data base which has assessments of 930 clients at three time points.
