Implementing Cognitive Remediation: From Lab to Clinic to Community
by Chelsea Wood-Ross and Dr Christopher Bowie, Lab Director at Queen's University Canada
We are psychologists in Ontario, Canada who research cognitive impairment in people who experience mental health issues. We try to understand why individuals experience challenges with cognition and based on this research, we develop treatments that aim to improve these challenges. We also focus on trying to improve every day functioning for individuals with our treatments.
We created a group-based intervention called Action Based Cognitive Remediation (ABCR) where we aim to improve both cognitive skills and everyday functioning by incorporating unique methods to role play functional skills that builds from computerized cognitive training. We include many of the features of traditional cognitive training and include group discussions of how cognitive skills can transfer to everyday functioning through role-play tasks that simulate real world functioning.
We’ve found that this treatment and other cognitive remediation programs are helpful for individuals experiencing mental health issues. We see improvements in both cognitive skills and real-world functioning. However, treatments for cognitive issues are not offered routinely within many health care systems in Ontario or the rest of Canada. We were curious to see how our treatment, designed and tested in a lab, would translate to the community clinics from the perspective of clinicians who work in the community.
Clinicians face major challenges in delivering intensive psychological interventions compared to well-funded research settings. We found that managerial support, staff time, and equipment were three of the main challenges that were reported by clinicians. Our community clinics often operate within a system with limited resources for mental health. Treatments like ABCR require resources and time of clinicians that might push the limits of what is available in routine clinical practice. When implementing a new treatment like ABCR, clinicians have to spend extra time preparing for sessions, writing session notes, and planning ahead; we found that this was often done without managerial support for reduced time in other activities.
Clinicians also reported making modifications to the original manual of the treatment. Most routinely, they reported reducing the number of sessions offered to patients and/or the length of the sessions. The clinicians that reported modifying the treatment also reported higher barriers with manager support than those that delivered it as manualized. Interestingly, they did not report worse patient outcomes.
We’ve learned a lot from this preliminary work so far. In research, we are lucky to have access to staff whose sole responsibility might be to run studies, funding to pay for equipment and to fund staff salaries, and as part of research, we have adherence to strict protocols to see how treatments work. When we try to translate this type of work into the community, we are still learning how it might be modified and whether those modifications affect the success of the program. Currently, we are replicating our efforts with a roll out of ABCR in another Canadian Province, with more robust measures of fidelity and patient outcomes. The long term goals are to feed back into our treatment materials to ensure the core features of the program can be feasibly delivered in routine care without negatively affecting treatment effects.
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