In a previous study, we found that cognitive adaptation training (CAT)--a manual-driven program of environmental supports designed to bypass cognitive deficits--improved multiple domains of outcome in schizophrenia patients recently discharged from a State psychiatric facility. The present study examined the efficacy of CAT in a sample of patients who had been in the community at least 3 months. Forty-five medicated schizophrenia patients were randomly assigned for 9 months to one of three conditions: (1) CAT, (2) a condition that controlled for therapist time and provided environmental changes unrelated to cognitive deficits, or (3) follow-up only. Comprehensive assessments were conducted every 3 months by blinded raters. Results of repeated measures analyses of covariance for mixed models indicated that patients participating in CAT had better adaptive function and quality of life, and fewer positive symptoms than those in the two non-CAT conditions. Results indicate that compensatory strategies may improve various outcomes in schizophrenia outpatients.