***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The Soteria project ( 1971–1983 ) compared residential treatment in the community and minimal use of antipsychotic medication with “ usual ” hospital treatment for patients with early episode schizophrenia spectrum psychosis . Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively ( 1971 to 1976 , N = 79 ) or r and omly ( 1976 to 1979 , N = 100 ) to the hospital or Soteria and followed for 2 years . Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder . Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways : for endpoint subjects ( N = 160 ) , for completing subjects ( N = 129 ) , and for completing subjects corrected for differential attrition ( N = 129 ) . Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment . Completing subjects had significantly better composite outcomes of a medium effect size at Soteria ( + .47 SD , p = .03 ) . Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment ( + .81 SD , p = .02 ) , particularly in domains of psychopathology , work , and social functioning .  Soteria treatment result ed in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses , particularly for completing subjects and for those with schizophrenia . In addition , only 58 % of Soteria subjects received antipsychotic medications during the follow-up period , and only 19 % were continuously maintained on antipsychotic medications A one-year cohort of patients from a defined catchment area with acute functional disorders were allocated at r and om to brief care ( experimental group ) or st and ard care ( control group ) in hospital to examine the effect of shortening hospital stay on the clinical and social functioning of patients and the distress abnormal functioning caused to others . A total of 127 patients were interviewed on entry to the study , and 106 were followed up . The brief care group had significantly shorter mean and median lengths of stay than the control group , but there was no difference between the groups in the number of days spent in hospital during subsequent admissions . The groups were well matched for clinical and social variables . Rates of improvement over 13 weeks were essentially the same by all measures of outcome , including the Present State Examination and Patient 's Behaviour Assessment Scale , which was developed for the study to measure deterioration in behaviour and social functioning and adverse effects and distress on others . There was no difference between the two groups in burden to the community supporting services , social security requirements , or GP attendances . Improvement rates were nearly identical on all measures within and across diagnostic subgroups . Brief care result ed in a 33 % reduction in average length of stay compared with the year before but was associated with a corresponding increase in day hospital use . The short-stay policy continued the year after the study finished . The findings confirm the value of shortening hospital stay and improving day care facilities for most localities Background : Today 's treatment of acute psychosis usually includes short-term hospitalization and anti-psychotic drug treatment . The Soteria project compared this form of treatment ( control ) with that of a small , home-like social environment , usually without neuroleptics ( experimental ) . Method : Newly diagnosed , young , unmarried persons with DSM-11 schizophrenia were r and omly assigned to treatment in two experimental and two control setting s.  Subjects and families were assessed at admission on 29 independent variables .  Treatment environments were studied by means of Moos ' , COPES or WAS scales . Three dependent six week psychopathology outcome measures were collected . Results : The groups were comparable on 25 of 29 admission variables . The environments of the two experimental and two control setting s were different from each other . The milieus were similar to each other within each condition . At six weeks , psychopathology in both groups had improved significantly , and similarly , and overall change was the same . Conclusion : Specially design ed , replicable milieus were able to reduce acute psychotic symptomatology within six weeks , usually without antipsychotic drugs , as effectively as usual hospital ward treatment that included routine neuroleptic drug use Following on a previous publication [ 15 ] , outcomes of 22 acute schizophrenic index patients treated mainly with no- or low-medication strategies and with milieu therapeutic , socio-therapeutic and psychotherapeutic methods in the open therapeutic community " Soteria Berne " are compared , in a 2-year prospect i ve study , with pairwise matched controls from 4 different traditional setting s. There were no significant differences concerning psychopathology , living situation , work situation , combined evaluation and relapse rate after 2 years . Total dosage of medication was less than half , but total costs about 1/3 higher in the index group . Differences of costs were directly related to the inclusion of the-often prolonged-phase of rehabilitation in the in-patient treatment in " Soteria " , and disappear when this phase is shifted to other setting s. These results and additional observations concerning subjective aspects speak in favour of the creation of other treatment facilities of the same type OBJECTIVE Severe and persistent mental illnesses are often lifelong and characterized by intermittent exacerbations requiring hospitalization . Providing needed care within budgetary constraints to this largely publicly subsidized population requires technologies that reduce costly inpatient episodes . The authors report a prospect i ve r and omized trial to test the clinical effectiveness of a model of acute residential alternative treatment for patients with persistent mental illness requiring hospital-level care . METHOD Patients enrolled in the Montgomery County , Md. , public mental health system who experienced an illness exacerbation and were willing to accept voluntary treatment were r and omly assigned  to the acute psychiatric ward of a general hospital or a community residential alternative . There were no psychopathology-based exclusion criteria . Treatment episode symptom improvement , satisfaction , discharge status , and 6-month pre- and postepisode acute care utilization , psychosocial functioning , and patient satisfaction were assessed . RESULTS Of 185 patients , 119 ( 64 % ) were successfully placed at their assigned treatment site . Case mix data indicated that patients treated in the hospital ( N = 50 ) and the alternative ( N = 69 ) were comparably ill . Treatment episode symptom reduction and patient satisfaction were comparable for the two setting s. Nine ( 13 % ) of 69 patients r and omly assigned to the alternative required transfer to a hospital unit ; two ( 4 % ) of 50 patients r and omly assigned to the hospital could not be stabilized and required transfer to another facility . Psychosocial functioning , satisfaction , and acute care use in the 6 months following admission were comparable for patients treated in the two setting s and did not differ significantly from functioning before the acute episode . CONCLUSIONS Hospitalization is a frequent and high-cost consequence of severe mental illness . For patients who do not require intensive general medical intervention and are willing to accept voluntary treatment , the alternative program model studied provides outcomes comparable to those of hospital care OBJECTIVE A variety of alternatives to acute psychiatric hospital care have been developed over the past several decades . including San Diego 's short-term acute residential treatment ( START ) program , now comprising a certified and accredited network of six facilities with a total of 75 beds . This study compared outcomes , patient satisfaction , and episode costs for a sample of 99 veterans who received acute care either at an inpatient unit at a Department of Veterans Affairs ( VA ) hospital or at a START facility . METHODS Consenting participants were r and omly assigned to one of the two treatment setting s. Follow-up was conducted at two months . During the follow-up period , participants received treatment as usual . Multiple st and ardized measures were used to maximize validity in assessing symptoms , functioning , and quality of life . RESULTS Participants who were treated in either a hospital or the START program showed significant improvement between admission , discharge , and two-month follow-up , with few statistically significant differences between the groups in symptoms and functioning . There was some evidence that START participants had greater satisfaction with services . Mean costs for the index episode were significantly lower for START participants ( 65 percent lower ) than for those who were treated in the hospital . CONCLUSIONS The results of this study suggest that the START model provides effective voluntary acute psychiatric care in a non-hospital-based setting at considerably lower cost . Efforts to replicate and evaluate the model at additional locations merit attention A comprehensive system of community treatment in southwest Denver has reduced the need for adult psychiatric inpatient beds to less than 1/100,000 population .  Six small , community-based therapeutic environments , crisis intervention , home treatment , social systems intervention , and rapid tranquilization comprise the essential components of this total community care system . The system operates within a framework of citizen participation and community control , the elimination of formal staff offices , and a focus on working in the real-life setting of the client and his family . To evaluate the effectiveness of community care , patients about to be hospitalized were r and omly assigned to a psychiatric hospital or to community alternative treatment .  Outcome measures at discharge and at follow-up completed by the client himself , treatment staff , and family members indicate that  community treatment was more effective than psychiatric hospitalization A total of 175 newly admitted in patients who lived with families were r and omly assigned to three treatment groups : st and ard inpatient care ( discharge at the therapist 's discretion ) , brief hospitalization ( one week or less ) with transitional day care available , and brief hospitalization without day care . Outpatient aftercare was offered to all patients . The three groups showed no significant differences as to amount of improvement in levels of psychopathology at 3 and 12 weeks , but the briefly hospitalized patients were able to resume their vocational roles sooner . There were no significant differences among the groups in readmission rates 
    Output:
    
Community-based residential crisis services may provide a feasible and acceptable alternative to hospital admission for some people with acute mental illness