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

Abstract

Aim Methods to identify and harness individual cognitive strengths while addressing relative weaknesses have the potential to complement recovery services for first‐episode psychosis but systematic implementation is needed. We developed a cognitive health toolkit, trained teams from OnTrackNY, a network of coordinated specialty care (CSC) programs and examined toolkit feasibility and clinical utility during the first year of roll‐out. Methods The toolkit includes a clinician manual, assessment and decision‐making tools, and a menu of cognitive health service options. Assessment uses the WRAT5‐Reading subtest and a new Self‐Assessment of Cognitive Functioning which, together, determine participant‐ and clinician‐perceived cognitive health need. Program‐level data were analysed for rates of assessment, identification of cognitive health needs and cognitive health service provision. Results Data from 18 OnTrackNY teams included 933 participants, including 310 new admissions. Across teams, 43.9% of newly admitted participants received a WRAT5‐Reading and 41.3% received a self‐assessment. Of all assessments completed in the study period, 50.7% were at or within 3‐months of admission and 69.1% were within the first year of program participation. Cognitive health need was identified by self‐report (57.6%) and clinician‐report (69.9%) and led to provision of specific services, including psychoeducation, compensatory skills training and in some cases restorative cognitive training. Conclusions Preliminary feasibility data are encouraging but barriers to assessment need to be identified and addressed. Rates of identified cognitive health need warrant further study of the implementation process and outcomes so that cognitive health assessment and treatment practices may ultimately be disseminated to CSC programs 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).…”

“…It is possible, for example, that treatment approaches with the strongest evidence base such as cognitive remediation are less appealing to young people and thus are less feasible in real‐world settings when compared to other approaches (e.g. cognitive compensation; Saperstein et al, 2020; Saperstein et al, 2021). This underscores the importance of considering cognitive treatment preferences within supportive shared decision processes in young people with mental illness, alongside information about the treatment and its availability, possible therapeutic benefits, risks and expected burden, and realistic alternative treatment options (Elwyn et al, 2017).…”

“…Compensatory interventions are shown to be effective in adults with severe mental illness (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). Sleep and other lifestyle factors are often addressed as part of mental health treatment more broadly but research on the value of sleep interventions to support cognitive health directly is limited.…”

Age-Specific Prevalence and Incidence of Dementia Diagnoses Among Older US Adults With Schizophrenia

“…For example, the US Food and Drug Administration’s black box warning of increased risk of death when antipsychotics are used by people with dementia directly contradicts recommendations for first-line treatment of schizophrenia. In the absence of evidence-based guidance on pharmacologic treatment strategies, an innovative approach is a cognitive health toolkit that provides materials for assessment and service planning . Additional research is needed to determine evidence-based pharmacotherapies for individuals with schizophrenia who develop dementia.…”