Feasibility and Acceptability of Providing Cognitive Remediation in a Large USA System of Coordinated Specialty Care for Early Psychosis

IntroductionMultinational treatment guidelines support providing cognitive remediation to people recently diagnosed with schizophrenia, but the feasibility of implementing the treatment on a large scale is less well understood. MethodsThis study took place between 2019 and 2023 at 14 clinics within a large network of programs providing early intervention services to people aged 16-30 experiencing nonaffective psychosis. Clinics were randomly assigned to deliver cognitive remediation as twice-weekly clinician-led groups (N = 5), cognitive remediation as once-weekly clinician-led groups with homework (N = 6), or treatment as usual (N = 3). All clinics screened for cognitive health need to guide treatment planning. Clinical teams (N = 11) received training to provide cognitive remediation. Program evaluation data were analysed for feasibility and acceptability. ResultsScreening for cognitive health needs was completed on 77% of the 1193 participants enrolled at the 11 clinics offering cognitive remediation. Clinicians identified cognitive difficulties in 53.9% (n = 496) of screened participants and referred 27% (n = 134) of these participants to cognitive remediation. Of referred participants, 77.6% (n = 104) initiated treatment, and n = 41 completed the treatment. The rate of referral was nearly double, and treatment initiation was significantly higher at programs delivering once-weekly (84.3%) than twice-weekly (64.4%) treatment but the difference in the rate of treatment completion was statistically nonsignificant. Satisfaction among treatment completers was high. ConclusionsReferrals to cognitive remediation required systemic support of a feasible cognitive health screening process. About a quarter of people with clinician-identified cognitive health needs were referred to cognitive remediation. Feasibility data suggest a flexible model of treatment delivery may facilitate implementation in this service setting.