Rehab Rounds : Predicting Rehabilitation Outcome Among Patients With Schizophrenia

Introduction by the column editors: Efforts to identify variables that predict outcomes among clients with serious and persistent mental illness span a quarter of a century (1,2,3). Within the realm of psychiatric rehabilitation, vocational performance has been the main outcome measure. For example, previous employment history has been found to be the best predictor of subsequent employment status (4). Most studies have found that the presence of psychotic symptoms predicts a negative vocational outcome, especially when symptoms and vocational status are measured concurrently (5,6,7). Mediating variables, such as a positive relationship between client and therapist and monetary incentives, have also been correlated with favorable vocational outcomes (8,9).In this month's column, Andrew Ferdinandi, Ph.D., and his colleagues at the Queens Day Center, a division of the Long Island Jewish Medical Center, venture off the beaten track of vocational performance by defining successful rehabilitation in other domains of community living such as socializing, learning, and developing independent living skills. The evaluation methodology used by the authors highlights the role of variables focused on subjective experience, in this case their clients' desire to make changes in their life circumstances, as an important predictor of rehabilitation outcomes. Thus to optimize the prediction of rehabilitation activities, the authors have merged their interest in objectively assessing community functioning with the subjective, self-stated goals of clients.