TAILORING TREATMENT FOR THE CHRONICALLY MENTALLY ILL

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The proposed research takes a first step toward tailoring treatment to the needs of young adult chronically mentally ill clients. Client differences in interpersonal functioning which interact with the interpersonal intensity of treatment will be examined. In particular, interpersonally intense treatment, e.g., case management, is expected to be optimal for individuals who are comfortable and secure in relationships, but not for those who are either preoccupied with relationships or dismissing of relationships. In this longitudinal study, 120 young adult chronically mentally ill adults will be randomly assigned to case management or to "standard care." Social support networks, general quality of life, use of treatment, time in psychiatric hospitals, and physical and psychiatric symptomatology will be assessed at six month intervals for three years. Individuals secure in relationships are expected to show more positive outcomes when in case management than in standard care, as evidenced by better use of treatment, less time hospitalized, etc. Individuals dismissing of relationships are expected to show the opposite pattern, becoming more symptomatic and using treatment more poorly, in case management. Individuals preoccupied with relationships are expected to show different types of problems in the two treatments. After three years, group and individual data will be used to reassign subjects who are inappropriately assigned to appropriate treatment. Following reassignment, subjects appropriately assigned are expected to show significant gains in functioning.