Disseminating action‐based cognitive remediation to an early psychosis network: Clinician perspectives on feasibility and implementation barriers

Abstract

AimAction‐based cognitive remediation (ABCR) is a group cognitive remediation treatment that aims to improve neurocognitive impairments experienced in patients with severe mental illness. Developed in research settings, ABCR is not yet widely available in community settings. As such, this study examines the feasibility of implementing ABCR in community clinics in an early psychosis network.MethodsEighty‐five allied health professionals who work within an early psychosis intervention network were trained in the provision of ABCR. They were surveyed 6‐months after training to gather information regarding their experience implementing ABCR within their clinical settings (e.g., barriers, perceived helpfulness of the treatment, modifications made to the manualized treatment). Access to ongoing training supports (e.g., treatment manual, asynchronous digital communication, conference calls) was also assessed.ResultsFifty‐one clinicians responded to the survey. Staff time, manager support, and equipment were rated as organizational barriers. Geographic location, other responsibilities, and motivation were rated as patient barriers. Over half of the sample modified the overall dose of ABCR to offer fewer sessions and/or shorter duration of sessions than the manualized approach. Clinicians that reduced the dose of ABCR reported significantly higher barriers with manager support than staff who delivered ABCR as manualized but did not report worse patient outcomes. We found asynchronous learning opportunities (i.e., manual, online discussion forum) were perceived as the most accessible and helpful methods of ongoing training support.ConclusionsThe results provide preliminary information about barriers to implementing time‐intensive cognitive treatments into clinical settings and may inform future training practices to increase successful implementation of cognitive remediation treatments.

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

“…CR design, consumer engagement, and organizational aspects are thus tightly linked, and all involved in CR dissemination efforts. Further examination of therapist and user experience (e.g., Hyde et al, 2020; Wood-Ross et al, 2023), as well as cost-effectiveness studies, are needed to increase organizational capacity to offer an evidence-based practice such as CR. As suggested in a recent Australian study by Davies and collaborators (Davies et al, 2023), research funding is needed to address the bench-to-bedside challenges of CR within local contexts of care.…”

“…The dissemination of evidence-based practices such as CR further depends on workforce perceptions around the intervention and the targeted symptoms (Corrigan et al, 2001). While only a few studies have investigated subjective accounts of consumers and healthcare professionals using CR (Bryce et al, 2018; Wood-Ross et al, 2023), it has been argued that cognitive health in schizophrenia may not always be perceived as a priority (Medalia & Erlich, 2017).…”

“…Large-scale implementation studies are scarce but show promising results for CR adoption in public settings where support is available (Dubreucq et al, 2019; Medalia, Saperstein, et al, 2019), with however significant barriers to the maintenance of programs (Cairns et al, 2013). Research has thus far suggested a lack of available resources and clinician time capacity, as well as consumer barriers, such as motivation or competing activities (Cairns et al, 2013; Dark et al, 2016; Wood-Ross et al, 2023). Indeed, significant dropout rates in CR are reported and remain poorly understood.…”