Enhancing Cognitive and Work/School Outcomes in First Episode Psychosis Using Cognitive Self-Management Strategies

August 1, 2026 updated by: Boston University Charles River Campus

Enhancing Cognitive and Work/School Outcomes in People With First Episode Psychosis: Testing the Effectiveness of Cognitive Self-Management Strategies

The goal of this pilot cluster randomized trial is to understand if adding a standardized cognitive self-management program, Thinking Skills for Work-Cognitive Self-Management Strategies (CSM) to Coordinated Specialty Care Supported Employment and Education (SEE) programs improves the work and school outcomes of young adults experiencing first episode psychosis. The main questions it aims to answer are:

  • Does adding the CSM program to usual SEE services lead to improved work and school outcomes, such as ability to find a job or enroll in school, or ability to keep a job or stay in school?
  • Does adding the CSM program to usual SEE services improve cognition and cognitive self-efficacy? Researchers will recruit six research sites and these will be randomized to either treatment as usual, where they will offer regular SEE services, or the experimental groups, where they will offer regular SEE services plus the CSM program.

Participants in both groups will be asked to complete a brief assessment at baseline, 6-months, 12-months, and 18-months. Participants in the experimental group will be asked to participate in the 12-session CSM program in addition to their regular SEE services.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The Coordinated Specialty Care (CSC) programs in the EPINET-TX Network provide Supported Employment and Education (SEE) services for young adults between the ages of 15-32 experiencing first episode psychosis (FEP). In this pilot cluster randomized clinical trial (RCT), six CSC programs representing different geographical regions including the urban southwest (serving a majority Latino population), the urban central and southeast (serving majority African American population), and the rural north and northeast (serving a racially/ethnically mixed population) that are part of the EPINET-TX Network will be recruited. Once the 6 SEE teams have been recruited, they will be randomized using a stratified procedure based on geographic region and populations served.

The 3 SEE teams randomized to the experimental group will be trained in CSM by the Boston University (BU) research team. During the training period, the CSC team program director and SEE specialist will be trained in CSM resources and methods, beginning with an online self-paced training course, followed by weekly and then biweekly zoom-based group supervision with BU researchers. CSM sessions will be audio-recorded as part of initial training and ongoing fidelity checks. Zoom meeting training sessions will also be recorded. CSM training is expected to take approximately three months, and the participating SEE programs will be reimbursed for staff training time. Designated site CSC personnel from both the experimental and the control group sites will be trained to administer the outcome assessments.

After training of CSC teams and assessors is complete, recruitment of young adults with FEP will begin at all 6 sites simultaneously. Recruitment of young adult participants will include information meetings conducted by the program directors of participating CSC programs, consent and assent meetings, and the baseline assessment. Once identified, these program directors will be added as staff on the Institutional Review Board (IRB).

The 6 CSC teams will then administer either the experimental intervention (CSM + SEE) intervention or the control intervention (SEE only). Staff within the experimental group will continue to receive support from the BU PI's, who will periodically administer the CSM Fidelity Scale to ensure CSM intervention fidelity.

Young adult participants in both the experimental and control groups will complete assessments at baseline, 6 months, 12 months, and 18 months. These assessments will take place in person by a trained onsite assessor. The baseline assessment battery will include a demographics questionnaire, history of employment and education questionnaire, the WRAT to assess reading level, and 2 cognitive assessments (described below). Follow-up assessments will only include the cognitive measures. These assessments are expected to take between 60-90 minutes for a total of 6 hours of time.

In addition, research sites will share the results of the Core Assessment Battery (CAB), an assessment that is administered as a part of routine CSC care every six months, with the BU researchers every 6 months. Additional information about prescribed medication, SEE program utilization, and psychiatric hospitalizations is normally collected quarterly and will be shared at each assessment. Education and employment logs will be collected weekly and shared with the BU research team. This information will be collected on all young adult participants.

Young adults with FEP in the experimental group will participate in the CSM intervention. The teaching of Cognitive Self-Management Strategies (CSM) by SEE specialists includes an additional 12 sessions that range from 45 to 60 minutes long. Thus, participants in the experimental group will complete about 18 hours of study activities over an 18-month period. Those in the control group will participate in the assessments, about 6 hours of study activities over an 18-month period.

After the study is over, participants from the control group still enrolled in the CSC program will be offered CSM if appropriate to their goals.

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Susan R McGurk, PhD
  • Phone Number: 617-353-3549
  • Email: mcgurk@bu.edu

Study Contact Backup

  • Name: Alexa Trolley-Hanson, MS
  • Phone Number: 617-353-3549
  • Email: athanson@bu.edu

Study Locations

  • United States
    • Texas
      • Big Spring, Texas, United States, 79720
        • Recruiting
        • West Texas Centers Promoting Behavioral and Developmental Health
        • Contact:
        • Principal Investigator:
          • Amanda Ryan, PhD
      • Granbury, Texas, United States, 76048
        • Recruiting
        • Pecan Valley Centers for Behavioral and Developmental Healthcare
        • Contact:
        • Contact:
        • Principal Investigator:
          • Molly Lopez, PhD
      • Laredo, Texas, United States, 78041
      • Longview, Texas, United States, 75604
        • Not yet recruiting
        • Community Healthcore
        • Principal Investigator:
          • Amanda Ryan, PhD
        • Principal Investigator:
          • Molly Lopez, PhD
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. currently in their first 18 months of enrollment in the CSC program
  2. at least 15 years of age
  3. receiving SEE services but not employed or enrolled in school
  4. have the desire to work or resume school.

Exclusion Criteria:

1) Young adults who are not fluent in english

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: CSM plus SEE Group
The 3 sites (30 participants) from this site will receive the standardized 12 session CSM program in addition to regular SEE services. The CSM sessions will occur weekly and last between 45-60 minutes. They cover 12 different areas of cognition such as self-assessment, recognizing strengths, challenging negative thinking, attention and concentration, memory organization, planning ahead, problem-solving, and thinking speed.
Behavioral: Thinking Skills for Work-Cognitive Self-Management Program (CSM)
CSM is a 12-session program that promotes the development of specific cognitive strategies to promote success in employment and education outcomes. This is a standardized, evidence-based intervention with adults with serious mental illness. Each session is facilitated by a trained cognitive specialist and lasts between 45- 60 minutes. Session topics include self-assessment of cognitive skills, recognizing strengths, challenging negative thoughts, attention and concentration, memory, organization, planning, and thinking ahead.
Behavioral: Treatment as Usual (TAU)
In this intervention, participants receive regular weekly Supported Education and Employment (SEE) services.
Active Comparator: Treatment as Usual
In this arm, the 3 sites (30 participants) will participate in regular weekly SEE services.
Behavioral: Treatment as Usual (TAU)
In this intervention, participants receive regular weekly Supported Education and Employment (SEE) services.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
School and Education Activity Tracker
Time Frame: Tracked weekly through study completion (about 18 months)
This qualitative measure tracks the participant's participation in education or employment activities on a weekly basis. It includes questions about the education or employment activity and the time spent completing the activity. The minimal value is 0, there is no maximum value.
Tracked weekly through study completion (about 18 months)
The Cognitive Problems and Strategies Assessment
Time Frame: Baseline, 6-, 12-, and 18-months
Standardized measure that assesses cognitive functioning and strategy use. It includes two subscales, the "Cognitive Problems Subscale" and the "Strategy Use Subscale", each consisting of 30 items that are scored from 0-3 (cumulative 0-90). A higher score on the Cognitive Problems Subscale indicates a worse outcome, whereas higher scores on the Strategy Use Subscale indicate better outcomes.
Baseline, 6-, 12-, and 18-months
Cognitive Self-Efficacy Scale
Time Frame: Baseline, 6-, 12-, and 18-months
Standardized measure that assesses an individual's confidence in everyday cognitive tasks. This is a 10 item scale with values ranging from 0 to 100, with higher values indicating better outcomes.
Baseline, 6-, 12-, and 18-months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The Clinical Outcomes in Measurement-based care Assessment of Symptoms and Severity (COMPASS-10)
Time Frame: baseline, 6-, 12-,18-months
This 10-item clinician-rated instrument evaluates positive, negative, and affective symptom severity for individuals experiencing early-phase or first-episode psychotic disorders. Rated on a scale from 0 (not present) to 6 (very severe). Lower values indicate treatment progress in this study.
baseline, 6-, 12-,18-months
The Global Functioning Social and Role Subscales
Time Frame: Baseline, 6-, 12-, 18-months
This 2 item scale measure was designed for young adults and measures a participant's social connections and daily responsibilities. This clinician-rated scale is scored from 1 to 10, where higher numbers indicate better outcomes.
Baseline, 6-, 12-, 18-months
The Personal Wellbeing Index
Time Frame: Baseline, 6-, 12-, and 18- months
This is a self-report, 8-item scale, that measures life satisfaction across standard of living, personal health, and relationships. Scores range from 0 (low-wellbeing) to 10 (high-wellbeing). Higher scores indicate better outcomes in this study.
Baseline, 6-, 12-, and 18- months
The Alcohol Use Scale
Time Frame: Baseline, 6-, 12-, and 18-months

This study uses 1 item from this scale, "Please rate your worst 1 month over the past 6 months."

Participants report the following ratings:

  1. Abstinent
  2. Use with Impairment
  3. Mild Alcohol Use
  4. Moderate Alcohol Use
  5. Severe Alcohol Use Lower scores indicate better outcomes.
Baseline, 6-, 12-, and 18-months
The Drug Use Scale
Time Frame: Baseline, 6-, 12-, and 18-months

This 1-item self-report scale measures a participant's drug use over the past 6 months. Participants report the following ratings:

  1. Abstinent
  2. Use with Impairment
  3. Mild Drug Use
  4. Moderate Drug Use
  5. Severe Drug Use Lower scores indicate better outcomes
Baseline, 6-, 12-, and 18-months
Substance Use Abuse Treatment Stage
Time Frame: Baseline, 6-, 12-, and 18-months

This 1 item scale measures the extent to which a participant is engaged in treatment for their substance use. It is a self-report scale in which the participant chooses one of the following options:

  1. pre-engagement, no contact with substance use treatment services
  2. engagement, limited contact with substance use treatment services
  3. early persuasion, regular contact but no change in use
  4. late persuasion, regular contact with reductions in use
  5. early active treatment, regular contact, reductions in use for 1 month
  6. late active treatment, regular contact, reductions in use and working towards abstinence
  7. relapse prevention=regular contact, achieved abstinence for 6 months, occasional relapses
  8. remission/recovery, no problems with substance use Higher scores indicate better outcomes
Baseline, 6-, 12-, and 18-months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Demographics Form
Time Frame: Baseline only
Standardized set of questions about a participants age, gender, race/ethnicity, gender, and diagnosis
Baseline only
History of employment and education
Time Frame: Baseline only
Standardized set of questions about an individual's past employment and education activities
Baseline only

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Boston University Charles River Campus

Collaborators

University of Texas

Investigators

  • Principal Investigator: Susan R McGurk, PhD, Boston University Center for Psychiatric Rehabilitation
  • Principal Investigator: Kim Mueser, PhD, Boston University Center for Psychiatric Rehabilitation

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 10, 2025

Primary Completion (Estimated)

January 31, 2029

Study Completion (Estimated)

May 31, 2029

Study Registration Dates

First Submitted

May 13, 2026

First Submitted That Met QC Criteria

August 1, 2026

First Posted (Actual)

August 6, 2026

Study Record Updates

Last Update Posted (Actual)

August 6, 2026

Last Update Submitted That Met QC Criteria

August 1, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 7734E
  • 90RTEM0004 (Other Grant/Funding Number: Nat. Institute on Disability Indep. Living and Rehab Research)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

There are no plans to share IPD from this trial

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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