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

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.

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