The project proposed here is an experimental field demonstration and evaluation of a recently developed mental health service model for the rehabilitation of severely mentally ill (SMI) patients, especially those involved in, or eligible, for Community Support Programs. This approach combines core elements of two of the most effective psychosocial treatments developed to date: the Training in Community Living (TCL) model and the psychoeducational multi-family group (PEMFG) approach. We call the resulting combination Family-Aided Assertive Community Treatment (FAACT). These family groups are a unique and powerful resource for the TCL team in job development and in solving problems of job finding and retention. Preliminary results in a nearly completed trial include a large main effect for FAACT on vocational achievement. This application proposes an experimental design which will compare vocational outcome in FAACT with that in conventional vocational rehabilitation (CVR). 144 unemployed but stabilized psychiatric patients meeting New York State Community Support Services criteria will be recruited, matched, randomly assigned to rehabilitation condition, rehabilitated and evaluated longitudinally. The project will be carried out in two typical community mental health centers which have close ties to excellent vocational rehabilitation services. Its results will serve as a guide to policy-making as New York State reconfigures its entire adult mental health system to emphasize psychiatric rehabilitation and consumer and family participation. The goals of the proposed project are to: 1. compare vocational adjustment, psychiatric symptoms, social functioning, quality of life, community tenure and costs of services in the two approaches; 2. compare cumulative effects over eighteen months; 3. identify patient and family characteristics that may be associated with better vocational adjustment in each approach; and 4. conduct the research through a meaningful Public- Academic Liaison. The research design includes: stratification and matching for work history and diagnosis, random assignment, fidelity-oriented clinical supervision, longitudinal assessments by independent raters and multivariate statistical analysis techniques to examine main effects and interactions of rehabilitation method with vocational, psychiatric and demographic variables.
