REACH Study (Recovery Environments: Assessing Cognitive & Brain Health in Community Mental Health)

Case Western Reserve University

Status: Not yet enrolling

Conditions: Schizophreniform Disorders; Schizophrenia; Schizo Affective Disorder

Treatments: Behavioral: Usual Community-Based Mental Health Care; Behavioral: Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Study type: Interventional

Funder types: Other

Identifiers

NCT07006935

STUDY20250623

Details and patient eligibility

About

The purpose of this study is to understand how different types of community-based mental health care affect thinking abilities, daily functioning, and brain activity in adults with schizophrenia and related conditions. The investigators are especially interested in learning whether the Clubhouse Model-a structured, supportive community for individuals with mental illness-has unique benefits compared to standard outpatient mental health services. If participants decide to join, they will be asked to complete a total of six study visits with the research team over the course of your participation. Three of these study visits are at the beginning (baseline) and the remaining three are six months later. Two of the three visits will includes interviews, questionnaires, and thinking and memory tasks (cognitive testing) and one session will be an MRI brain scan, which is a safe and non-invasive imaging procedure. The total time required for each visit will be approximately 90 minutes to two hours. Participants may take breaks as needed.

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• (1) have a DSM-V diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform confirmed by diagnostic assessment and medical record review
• (2) between the ages of 18-50
• (3) stabilized on psychotropic medication as indicated by no changes to the primary psychiatric medication in the last month
• (4) able to read and speak fluent English at a sixth grade level or higher for purposes of informed consent and cognitive testing
• For Clubhouse members, they must be a first-time, newly enrolled member

Exclusion criteria

• (1) had previous membership at a Clubhouse (Magnolia or elsewhere)
• (2) have a current severe substance use disorder
• (3) have persistent suicidal or homicidal behavior
• (4) a co-occurring diagnosis of an intellectual or learning disability or neurodevelopment condition (e.g., Autism; based on chart review)
• (5) had recent psychiatric instability requiring hospitalization in the past month;
• (6) history of a traumatic brain injury (TBI; based on record review)
• (7) contraindicators for MRI (e.g., pacemaker, claustrophobia)
• Participants in the usual care will be excluded if they are a current Clubhouse member or join a Clubhouse during participation in this research

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups

Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Experimental group

Description:

The Clubhouse Model (CM) is a strengths-focused, evidence-based, and comprehensive approach to psychosocial rehabilitation for serious mental illness. The CM uses an intentional community of support to create a safe and holistic setting to practice real-world functioning. The core of the CM is the 'work-ordered day,' a concept where members, as opposed to patients, are integral to and needed for the successful daily operation of the Clubhouse. Members choose a 'work unit' each day of attendance. Most clubhouses have four work units, such as (1) Administration (e.g., database management); (2) Hospitality (e.g., Clubhouse cafe); (3) Membership (e.g., employment programs); and (4) Communications (e.g., newsletter). Other unique aspects include its voluntary and humanistic nature, prioritization of member choice, unrestricted and flexible membership, and the elimination of provider-patient hierarchy. The CM has a sophisticated accreditation process based on 37 international standards.

Treatment:

Behavioral: Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Usual Community-Based Mental Health Care

Active Comparator group

Description:

Usual care includes services typically available in the community at mental health agencies, including case management, Assertive Community Treatment, counseling, peer support services, psychoeducational support groups, family support groups, supported education/employment, permanent supportive housing, and medication management.

Treatment:

Behavioral: Usual Community-Based Mental Health Care