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. 2018 Jun 15;18(1):458.
doi: 10.1186/s12913-018-3240-5.

Implementing cognitive remediation and social cognitive interaction training into standard psychosis care

Frances Dark  1   2 , Meredith Harris  3   4 , Victoria Gore-Jones  5   6 , Ellie Newman  1 , Harvey Whiteford  3   4
Affiliations

Implementing cognitive remediation and social cognitive interaction training into standard psychosis care

Frances Dark et al. BMC Health Serv Res. .

Abstract

Background: To evaluate the planned implementation of group based Cognitive Remediation therapy (CR) and Social Cognitive Interaction Training (SCIT) into routine psychosis care in a mental health service in Australia.

Method: The study was conducted over 3 years in a mental health service in a metropolitan city in Australia. Participants were 22 program facilitators and 128 patients attending the programs. Implementation outcomes were assessed using administrative data, staff surveys and program audits.

Results: There was fidelity to the particular therapies at a program level. Programs were assessed as being feasible within the study setting with each hospital district developing a capacity to run CR and SCIT. The establishment of new programs improved the reach, but waiting lists indicate a need to expand capacity. There was a relatively high dropout and several factors impacted on completion of the programs - notably, acute exacerbation of psychosis. Once initiated the therapies were acceptable with no-one ceasing SCIT due to loss of interest and only 10% of participants ceasing CR due to loss of interest. Annual audits of programs found programs established were maintained and facilitators were retained.

Conclusion: SCIT and CR programs were successfully implemented in three hospital districts. Several factors impeded participants receiving the recommended "dose" of the programs. The maintenance of the programs in the short term is encouraging in regards to organisational fit. Dissemination of cognitive rehabilitation programs to a service population takes planning. An implementation plan is essential for guiding development and maintenance of programs. These therapies are best suited to people in a stable phase of illness. Service user co-production is recommended to improve recruitment in future studies.

Keywords: Cognitive remediation; Implementation outcomes; Mental health services; Schizophrenia; Social cognitive interaction training.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Metro South Health Human Research Ethics Committee (HRE/13/QPAH/16). The study was explained to each participant, and a written informed consent was obtained from all participants prior to conducting the study.

Competing interests

The first author is a director of rehabilitation in the study site and was on the writing committee of the recently published Australian and New Zealand Schizophrenia Clinical Practice Guidelines. The authors alone are responsible for the content and writing of the paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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