Addressing cognitive health in coordinated specialty care for early psychosis: Real‐world perspectives

Abstract

Aim Addressing cognitive health during the early phase of psychosis has the potential to enhance recovery outcomes, yet methods to assess and treat cognitive problems are not a systematic part of Coordinated Specialty Care (CSC) in the United States. We sought to understand how CSC providers perceive cognitive health and gauge the acceptability and appropriateness of cognitive interventions to inform the development and implementation of a cognitive health toolkit for OnTrackNY, a CSC program. Methods Electronic surveys were sent to clinicians from 22 OnTrackNY teams. One unstructured and 10 structured questions assessed knowledge and beliefs about cognition, current cognitive health practices, the likelihood of adopting new practices, perceived facilitators, and barriers to assessing and treating cognitive health. Results Fifty‐three clinicians responded. Clinicians identified a range of terms associated with cognitive impairment with specific neurocognitive deficits cited most frequently. The majority perceived the evidence for cognitive impairment at the time of first episode to be moderate to strong, that specific interventions for cognition are warranted, and that there is a significant link between cognition and community functioning. While current practices vary, 88% indicated a high likelihood of integrating tools to address cognitive problems if provided. Compensatory approaches to aid cognitive functioning were viewed most favourably. Conclusions Results suggest that addressing cognitive health is acceptable and appropriate for OnTrackNY but there is a need for systematic training to integrate empirically supported interventions with existing recovery‐oriented practices. Piloting a cognitive health toolkit will inform the potential uptake of assessment and treatment practices more broadly.

Cognitive health treatment priorities and preferences among young people with mental illness: The your mind, your choice survey

“…The current study provides some insights into the cognitionfocused treatments that young people with mental illness may find (Allott, van-der-el, et al, 2020); however, few trials have tested the effectiveness of compensatory interventions with young people, especially those with high prevalence conditions. Notably, research in early psychosis settings, which often serve a high proportion of young people with cognitive impairment, has found that compensatory interventions and psychoeducation are considered by clinicians to be the most feasible treatments to deliver (Saperstein et al, 2020;Saperstein et al, 2021).…”

“…While this observation may partly explain the discrepancy between the young people's cognitive needs and the provision of suitable treatments, it may also highlight a need for further workforce development. Supporting clinicians to routinely conduct cognitive screening and implement strategies with young people may be an important first step in addressing this need (Bryce & Allott, 2019; McIntyre et al, 2019; Saperstein et al, 2020; 2021).…”

“…This may contribute to the large gap that exists between research innovations and translation to real‐world practice, and points to a need for greater focus on the implementation of cognitive health interventions in youth mental health settings (Bryce, Zbukvic, et al, 2021; Medalia et al, 2019). A better understanding of which cognitive enhancing treatments may be acceptable to consumers and clinicians can help to address the implementation barriers that often exist in early intervention services (Lammas et al, 2022; Saperstein et al, 2020).…”

Toolkit for assessing and addressing cognitive health in early psychosis: Evaluation of feasibility and utility in a coordinated specialty care setting

“…Service provision relies on shared decision‐making, using the assessment results as a reference. A menu of cognitive health services recognizes that no one approach to cognitive health is right for all persons and accounts for the variable resources, knowledge and interests reported by OnTrackNY teams (Saperstein et al, 2020). The menu includes psychoeducation for program participants and for family members (Medalia & Revheim, 2002), compensatory skills training (Twamley et al, 2003) and a restorative approach to cognitive remediation (Medalia & Saperstein, 2019).…”

“…In a program evaluation study conducted with 22 OnTrackNY teams operating in a diverse array of healthcare settings (Saperstein et al, 2020), we found that cognitive health assessment and treatment practices ranged in type as well as frequency. Importantly, while providers identified numerous facilitating factors that would support the adoption of such practices, lack of knowledge of how to discuss cognitive health emerged as a significant barrier.…”