Relationships among program components, social environment, and member functioning in psychosocial rehabilitation programs for seriously mentally ill individuals

Psychosocial rehabilitation services are designed to assist seriously mentally ill individuals reach higher levels of functioning by providing skill-building opportunities and environmental support. This broad conceptualization encompasses an extensive array of both inpatient and outpatient services. While empirical studies have documented the effectiveness of individual psychosocial rehabilitation programs, few studies have identified specific programmatic mechanisms associated with enhanced functioning.^ The current study was the first to employ a multiple-site sampling methodology to evaluate services in general, rather than specific programs or individual outcomes. Three primary goals included: (1) taking a state-wide inventory of psychosocial rehabilitation services, thereby highlighting organizational dimensions; (2) testing hypotheses that clubhouse-model services would be positively related to social environment and member psychosocial functioning; and (3) evaluating a model predicting positive relationships among program components, social environment, and member psychosocial functioning variables. This model further hypothesized that social environment characteristics would mediate relationships between program components and member functioning.^ A total of 22 out of 24 Connecticut psychosocial rehabilitation programs participated. Data were gathered from multiple sources, including internal DMHAS records, interviews with program staff, researcher ratings, and member self-report questionnaires. A sample of 275 members rated their feelings of self-esteem, hope, consumer satisfaction, and social functioning, as well as perceptions of program social climate and mutual empowerment. Bivariate, partial correlation, and hierarchical regression analyses were used to evaluate hypotheses.^ Results highlighted three main dimensions along which psychosocial rehabilitation program services varied: clubhouse, psychoeducation, and recreation. Hypotheses that clubhouse services would be positively related to social environment and member psychosocial functioning were not substantiated. Instead, results favored social, vocational, and educational programming with strong psychoeducational components. Skill-building groups, educational colloquia, supported employment programs, and adult education support services were positively related to functioning variables, particularly self-esteem and hope. Positive associations were also found between consumer-managed, community-based, and self-help activities and aspects of social functioning. Data further supported the hypothesis that social environment variables mediate the effectiveness of program services. In particular, educational rehabilitation services may work by engendering mutually empowering social environments, thereby increasing member feelings of hopefulness. Future directions for research are presented.