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Cognitive remediation can be implemented in large systems of psychiatric care

Cognitive remediation, an evidence-based, recovery-oriented behavioral intervention for patients with mental illness, can feasibly be implemented in large systems of care, according to researchers at the New York State Psychiatric Institute and Columbia University Irving Medical Center.

The findings were published online today, May 3, 2018, in CNS Spectrums.

Cognitive remediation, which targets the information processing skills that underlie thinking, is used to enhance cognitive skills so that people with serious mental illnesses function better in everyday life. There is increasing enthusiasm to provide cognitive remediation as an evidence-based practice, but relatively little is known about how to best implement it in mental health care systems. The exact steps of implementation remain a mystery to many stakeholders, making a process paper timely.

“This paper describes the work that has been done to implement cognitive remediation throughout New York State’s psychiatric hospital system, the first statewide implementation of this treatment in the USA,” noted lead author Alice Medalia, Ph.D., a research psychologist at New York State Psychiatric Institute and professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons. “Our goal was to better understand the implementation issues which care providers are likely to face when bringing cognitive remediation services to their patients.”

In 2014, the researchers set up a Cognitive Health Service that could be offered to patients throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits (such as problems with attention, memory, and processing speed) commonly associated with psychiatric illnesses are recognized and addressed, and to make sure that cognitive health is embedded in the vocabulary of wellness.

By 2017, New York State offered cognitive remediation to patients with serious mental illness at 13 of 16 adult psychiatric centers. The embedded quality assurance program evaluation tools indicated that cognitive remediation was sustainable and effective.

Along with hundreds of state licensed facilities, these adult psychiatric centers are an essential part of the New York State Office of Mental Health, which oversees the care of more than 700,000 patients annually in both urban and rural areas, including almost 20,000 unique adult patients. “To implement the service, we first needed to create a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning,” said Dr. Medalia.

The success of this project shows that cognitive remediation can feasibly be implemented in large systems of care. Dr. Medalia maintains that “the systems must provide a multi-level system of supports, a training program that educates broadly about cognitive health (and specifically about the delivery of cognitive remediation), and an embedded, ongoing program evaluation that is linked to staff supervision.”

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