***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: Consumers with serious mental illness ( N=166 ) enrolling in two community-based mental health programs , a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development ( ICCD )  , were asked about their interest in work . About one third of the new enrollees expressed no interest in working . Equivalent supported employment services were then offered to all participants in each program . Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job . Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service . Once employed , these two groups held comparable jobs for the same length of time . These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness , and the viability of integrating these services into routine mental health care OBJECTIVE This purpose of this study was to determine whether participation in the Work-Ordered Day program of the Clubhouse model has a positive effect on vocational outcomes . METHOD The longitudinal study followed a group of individuals with severe mental illness who were r and omly assigned either to a Clubhouse program or a Program of Assertive Community Treatment team .  Study participants were tracked for 135 weeks . These analyses evaluated the relationship between Work-Ordered Day participation and employment duration for the 43 study participants enrolled in the Clubhouse program who were active throughout the study and competitively employed during the study . RESULTS Participation in the Work-Ordered Day program had a significant positive impact on average duration of employment . On average , a 1-hr increase in participation prior to employment led to an increase of 2.3 weeks in competitive employment . CONCLUSIONS AND IMPLICATION S FOR PRACTICE Participants with more Work-Ordered Day program participation prior to employment had significantly longer average competitive employment duration even when controlling for prior work history . Participation in the Work-Ordered Day program is likely to improve work readiness . Further research is warranted to study which elements of the program may foment employment success . This could lead to increased implementation of the Work-Ordered Day program and its elements as precursors to employment for adults with severe mental illness Background Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness . This study evaluated the implementation , technical assistance , and perceived impact of a model curriculum ( " Learning About Healthy Living " ) to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses . Methods We used semi-structured interviews  ( n = 9 ) with clubhouse staff ( n = 12 ) and a survey of participating clubhouse members ( n = 271 ) in nine clubhouses . Results Fifty-eight percent of clubhouse participants completed surveys . Results showed tobacco users open to tobacco-free policies ( 62 % ) and perceiving more discussion s about quitting tobacco with healthcare providers ( 69 % ) . Analyses of staff interviews and member surveys revealed four key themes : ( 1 ) the curriculum was successfully implemented and appreciated ; ( 2 ) technical assistance kept implementation on track ; ( 3 ) adding wellness content and interactive components should enhance the curriculum ; and , ( 4 ) the curriculum advanced other healthful policies and practice s. Conclusions Mental health setting s are important locations for implementing programs to address tobacco use . In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses , the curriculum tested well , was feasible and well-received , and suggests potential impact on tobacco use outcomes . Revision , dissemination , and a r and omized controlled trial evaluation of the model curriculum should now occur The Program Environment Scale ( PES ) was developed for use with clients of community-based programs for the severely mentally ill . It is intended to fill the gap in available tools for assessing clients ' perceptions of program functioning as it affects their “ quality of life ” in a program . Formal pretests were conducted with 121 clients at 12 r and omly selected programs near Washington , DC . The final field test used a revised form ( 29 domains ; 129 items ) with 221 clients in 22 programs selected r and omly throughout the U.S. , including Clubhouse , day treatment , psychosocial rehabilitation , and social club programs . Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity . A 24th subscale was retained because of its substantive importance . Successful subscales cover program atmosphere and interactions ( program cares about me , energy level , friendliness , openness , staff-client and client-client respect , reasonable rules , availability of positive physical contact , protection from bad touch , staff investment in their jobs , and confidentiality ) , client empowerment/staff-client e quality ( program and treatment empowerment , egalitarian space use ) , and service components ( support for paid work , work importance , emergency access , family activities , housing , public benefits , community activities , medications , substance abuse , and continuity ) . Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services , and by an ability to differentiate among program models ( i.e. , Clubhouses , day treatment programs , and psychosocial rehabilitation programs look different from each other ) . Subscale scores were not influenced by client characteristics ( gender , race , age , diagnosis , number of hospitalizations , length of time in program ) . The final scale has 97 items and takes about 25 minutes to complete . The PES succeeds in measuring different aspects of programs as clients perceive them . In the programs we visited , directors felt the PES covers the important things they want to know about how clients perceive their program . The PES should become a useful tool both for research ers interested in how client responses to programs may influence their therapeutic outcomes , and for practitioners interested in improving their clients ' program experiences and /or increasing convergence of staff and client views of their program OBJECTIVE Despite the large number of Latinos living in the United States , little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population . This article presents a secondary analysis of a r and omized , controlled trial comparing supported employment with 2 other vocational rehabilitation programs in 3 ethnic/racial groups of participants with severe mental illness : Latinos , non-Latino African Americans , and non-Latino Whites . METHOD The data were drawn from a previously published r and omized , controlled trial comparing supported employment with st and ard vocational rehabilitation services and a psychosocial clubhouse program in persons with severe mental illness ( Mueser et al. , 2004 ) , including 64 Latinos , 91 non-Latino African Americans , and 43 non-Latino Whites . Comparisons were made between the 3 groups at baseline on demographic characteristics , clinical and psychosocial functioning , and quality of life . Within each ethnic/racial group , competitive employment and all paid employment outcomes were compared between the 3 vocational rehabilitation programs over the 2-year study period . RESULTS At baseline , the Latino participants had lower levels of education and disability income , were less likely to have worked competitively over the previous 5 years , had more severe symptoms , and worse psychosocial functioning than the non-Latino African American or non-Latino White participants . Latinos r and omized to supported employment had better competitive and all-paid work outcomes than those assigned to either st and ard services or the psychosocial clubhouse program , similar to the non-Latino consumers . Rates of competitive work for consumers in supported employment were comparable across all 3 racial/ethnic groups . DISCUSSION Supported employment is effective at improving competitive work in Latinos with severe mental illness . Efforts should be made to increase access to supported employment in the growing population of Latinos with severe mental illness A r and omized trial comparing a  facility-based Clubhouse ( N = 83 ) to a mobile Program of Assertive Community Treatment ( PACT ; N = 84 ) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness . R and om regression analyses showed that , over 24 months of study participation , competitively employed Clubhouse participants reported greater global quality of life improvement , particularly with the social and financial aspects of their lives , as well as greater self-esteem and service satisfaction , compared to competitively employed PACT participants . However , there was no overall association between global quality of life and competitive work , or work duration . Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment . Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses , including the possibly essential role of Clubhouse employer consortiums for providing high-wage , socially integrated jobs The authors compared 3 approaches to vocational rehabilitation for severe mental illness ( SMI ) :  the individual placement and support ( IPS ) model of supported employment , a psychosocial rehabilitation ( PSR ) program , and st and ard services .  Two hundred four unemployed clients ( 46 % African American , 30 % Latino ) with SMI were r and omly assigned to IPS , PSR , or st and ard services and followed for 2 years . Clients in IPS had significantly better employment outcomes than clients in PSR and st and ard services , including more competitive work ( 73.9 % vs. 18.2 % vs. 27.5 % , respectively ) and any paid work ( 73.9 % vs. 34.8 % vs. 53.6 % , respectively ) . There were few differences in nonvocational outcomes between programs . IPS is a more effective model than PSR or st and ard brokered vocational services for improving employment outcomes in clients with SMI Service fit , defined as consistency between mental health services judged needed and services received was measured for a r and om sample of service recipients in a public mental health system ( N = 6588 ) . A variant of small area analysis was used to measure the relationship between catchment area mortality rates from natural causes , suicide , and medicolegal causes and area fit scores for a variety of services . We tested the theory-based hypothesis that service fit would predict interarea variations in mortality better than simple measures of amount of service prescribed and received . We also tested the hypothesis that , controlling for relevant demographic and clinical factors , fit would be protective for mortality from all causes . Findings supported the first hypothesis . With respect to the second , service fit for only certain services was protective . Housing and clubhouses services were particularly protective , suggesting the importance of services providing social support BACKGROUND : Following the lead of evidence -based medicine , practice based on effectiveness research has become the new gold st and ard of contemporary public policy . Studies of this sort are increasingly dem and ed to evaluate services provided by mental health , social services and criminal justice systems . AIMS : The paper questions whether the simple r and omized controlled trial ( RCT ) paradigm as applied in clinical trials can be used " off the rack " to evaluate socially complex service ( SCS ) interventions . These are services that are characterized by complex , diverse and non-st and ardized staffing arrangements ; ambiguous protocol s ; hard-to-define study sample s and unevenly motivated subjects and dependence on broader social environments . The difficulty of ensuring precise protocol s , equivalent groups ( tied to a meaningful target population ) and neutral and equivalent trial environments under real world conditions are explored , as are the implication s of not achieving st and ardization and equivalence . METHODS : Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions , as illustrated by programs targeted to mentally disordered offenders in Britain . RESULTS : SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity , reliability and generalizability of inferences of SCS trials . DISCUSSION : The RCT is not a panacea . Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid , reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias , unmeasured variables and endogeneity . Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services . IMPLICATION S : It remains an empirical issue whether RCT -based services effectiveness research can inform mental health policy . Without major design innovations , it is more likely that the information generated by this research will have limited practical use , especially if the RCT model is unable to control for the effect of social complexity and the interaction between social complexity and dynamic systemic change . Scientific evaluations of services make clinical and economic sense so long as they are design ed to meet the challenges of the services of which they promise greater knowledge OBJECTIVE In a r and omized controlled trial , a vocationally integrated program of assertive community treatment ( ACT ) was compared with a certified clubhouse in the delivery of supported employment services . METHODS Employment rates , total work hours , and earnings for 121 adults with serious mental illness interested in work were compared with published benchmark figures for exemplary supported employment programs . The two programs were then compared on service engagement , retention , and employment outcomes in regression analyses that controlled for background characteristics , program preference , and vocational service receipt . RESULTS Outcomes for 63 ACT and 58 clubhouse participants met or exceeded most published outcomes for specialized supported employment teams . Compared with the clubhouse program , the ACT program had significantly ( p<.05 ) better service engagement ( ACT , 98 percent ; clubhouse , 74 percent ) and retention ( ACT , 79 percent ; clubhouse , 58 percent ) over 24 months , but there was no significant difference in employment rates ( ACT , 64 percent ; clubhouse , 47 percent ) . Compared with ACT participants , clubhouse participants worked significantly longer ( median of 199 days versus 98 days ) for more total hours ( median of 494 hours versus 234 hours ) and earned more ( median of $ 3,456 versus $ 1,252 total earnings ) . Better work performance by clubhouse participants was partially attributable to higher pay . CONCLUSIONS Vocationally integrated ACT and certified clubhouses can achieve employment outcomes similar to those of exemplary supported employment teams . Certified clubhouses 
    Output:
    
RCT results support the efficacy of the Clubhouse Model in promoting employment , reducing hospitalization(s ) , and improving quality of life .