Delivering Socially Oriented Treatments to Persons with Schizophrenia Using Telementalhealth Procedures: Overcoming Challenges in a PCORI-funded Comparative Effectiveness Trial

Russell Schutt, PhD

Beth Israel Deaconess Medical Center
Delivering Socially Oriented Treatments to Persons with Schizophrenia Using Telementalhealth Procedures: Overcoming Challenges in a PCORI-funded Comparative Effectiveness Trial

Scientific Abstract

Background: Social distancing restrictions imposed as a result of the COVID-19 pandemic constrain guided social interaction to improve community functioning just when it is most needed. Or do they? Has availability of telementalhealth (TMH) procedures overcome social distancing barriers? We review current research on this question, report findings from a survey of clinicians, and present the redesign of our comparative effectiveness study of two socially oriented treatments for patients with schizophrenia-spectrum disorders to a virtual modality.

Methods: The Patient-Centered Outcomes Research Institute (PCORI) funded our comparison of Cognitive Enhancement Therapy (CET) and Social Skills Training (SST) with a randomized cluster design for 378 patients at 19 sites. Treatments require one year of participation in group therapy sessions and individual engagement with a clinician. CET also requires computer-based cognitive remediation sessions, in pairs, while SST also requires monthly community trips. The March 2020 shutdown interrupted our preparation to deliver these interventions and forced us to review prior research and develop a plan for remote delivery of these procedures. We surveyed our site PIs about their experiences with remote procedures at all 19 service sites and we convened stakeholders to discuss our plans.

Results: Systematic research reviews have concluded that TMH outcomes are equivalent to those resulting from face-to-face interventions, but most have focused on persons with depression or anxiety. More limited research on persons with schizophrenia provides some evidence of TMH effectiveness but identifies challenges in group videoconferencing. All but three of our site PIs reported unchanged or reduced no-show rates when group therapy was delivered remotely, although patient reactions to the experience were not as positive. Most stakeholders were supportive.

Conclusions: Even complex socially oriented treatments can potentially be delivered through TMH. We are launching a pilot study to test the feasibility and acceptability of converting CET and SST to remote delivery before offering a TMH option at all our 19 treatment sites.

SoundCloud Transcript

Mental health services shifted abruptly last March from in-person to virtual modes of delivery.  Does the new approach work?

 

Hello. I’m Russell Schutt, and that is the question that Dr. Matcheri Keshavan and I had to answer when our $3 million trial of Cognitive Enhancement Therapy and Social Skills Training was put on hold just as we were preparing to recruit patients.

 

PCORI—the Patient-Centered Outcomes Research Institute—funds comparative effectiveness studies like ours to strengthen the evidence base for clinicians who must decide which treatment alternative to recommend.  Prior research establishes their efficacy in improving social and community functioning for persons with schizophrenia and related disorders.  Will both treatments still be efficacious when participation in their weekly therapy sessions as well as individual sessions is through video conferencing? 

 

This poster presents evidence we submitted to PCORI in our successful proposal for a pilot study to establish the feasibility and acceptability of shifting service delivery to a telementalhealth modality.

 

The evidence came from four sources:

  • A review of the research literature on telementalhealth;
  • Data about the shift to telementalhealth delivery in another PCORI project directed by our co-investigators Sarah Pratt and Kim Mueser;
  • Feedback by our local Principal Investigators about the shift to telementalhealth at the 19 service sites included in our randomized cluster design;
  • Patient reactions to telementalhealth service delivery, as captured by our site PIs.

 

Our poster concludes with a summary of the design of our pilot study of telementalhealth service delivery. 

Live Zoom Session – April 21st

research Areas

Authors

R.K. Schutt, PhD, R.I. Mesholam-Gately, PhD, L. Sandoval, PhD, LR. Golden, MA, M.A. Killam, BA, M.S. Keshavan, PhD Psychosis Research Program, Dept. of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School

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