Translating cognitive behavioral interventions from bench to bedside: The feasibility and acceptability of cognitive remediation in research as compared to clinical settings

Alice Medalia, Matthew D Erlich, Charlotte Soumet-Leman, Alice M Saperstein, Alice Medalia, Matthew D Erlich, Charlotte Soumet-Leman, Alice M Saperstein

Abstract

Cognitive remediation (CR) research typically addresses internal validity, and few studies consider CR in a real-world context. This study evaluated the fit between the program conditions and treatment model in research and clinical settings, with the goal of informing future research on the contextual challenges associated with the implementation of CR. Data was drawn from an initiative by New York State's Office of Mental Health (OMH), to implement CR programs for adults with Serious Mental Illness (SMI) in 16 state operated outpatient clinics. One of these clinics first became a research site for a CR randomized clinical trial, which allowed for a comparison of the feasibility and acceptability of CR in a research as compared to a clinical setting. RESULTS: The research site averaged almost triple the number of referrals as the clinical sites. Over nine months 46.51% of clinic referrals were enrolled in the CR program whereas 64.29% of research referrals were enrolled. Clinical site utilization averaged 70.53% while research site utilization averaged 90.47%. At the clinical sites, 97% of respondents reported CR was an excellent or good experience. There was high treatment fidelity for program structure and content across sites. CONCLUSIONS: This comparison of CR in clinical and research sites highlights the decrease in referrals, enrollment and utilization that occurs when a program moves from a highly controlled setting to the real world. Still, the acceptability, fill rates and utilization indicated that CR can be successfully implemented in large scale, geographically diverse, publically funded clinic settings.

Keywords: Cognitive remediation; Implementation; Serious mental illness.

Conflict of interest statement

Conflict of Interest : The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

Copyright © 2017 Elsevier B.V. All rights reserved.

Figures

Figure 1
Figure 1
Referrals to CR2PR over five calendar quarters
Figure 2
Figure 2
Satisfaction ratings for CR in clinical settings (N = 64) Rating of 4 is most positive. Ratings come from 8 sites
Figure 3
Figure 3
Satisfaction survey: Overall CR experience (N = 64)
Figure 4
Figure 4
Domains of improved engagement in outpatient clinic programs (N = 19*) * 19 of 28 rated clients showed more engagement in their clinic program
Figure 5
Figure 5
Domains of improved community engagement (N = 20*) * 20 of 28 rated clients showed more engagement in their community

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