Alice Medalia1, Matthew D Erlich2, Charlotte Soumet-Leman3, Alice M Saperstein4. 1. Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States; New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032, United States. Electronic address: alice.medalia@columbia.edu. 2. Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States; New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032, United States; New York State Office of Mental Health, NYC Field Office, 330 Fifth Avenue, New York, NY 10001, United States. 3. Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States. 4. Columbia University College of Physicians and Surgeons, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States; New York State Psychiatric Institute, Division of Behavioral Health Service and Policy Research, 1051 Riverside Drive, Mailbox 100, New York, NY 10032, United States.
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.
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.
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