Background: Can comprehensive psychosocial treatments based on weekly group therapy, cognitive remediation with a partner, and community engagement be delivered successfully with remote procedures? After the pandemic shutdown in March 2020, we conducted a pilot study to determine whether our comparative effectiveness trial of Cognitive Enhancement Therapy (CET) and Social Skills Training (SST), funded by the Patient-Centered Outcomes Research Institute (PCORI), would be feasible at our collaborating sites and acceptable to patients.
Methods: 28 adults diagnosed with schizophrenia, schizoaffective, or schizophreniform disorder were enrolled for the pilot at four of the 19 planned treatment sites in our study. Two sites delivered all treatment components in-person (one CET and one SST) and two delivered the same treatments remotely (one CET and one SST). All assessments (baseline only) were conducted remotely by RAs at BIDMC; site-level RAs helped to enter process and fidelity data in REDCap, while patients completed satisfaction measures (CSQ-8) directly. Five benchmarks were established with PCORI as descriptive standards for judging success after three months of treatment (which continues at each site for 12 months).
Results: Both the target enrollment of 4-8 patients per site and the standard of at least 60% patient retention were exceeded. The average 80% satisfaction survey completion rate and the average satisfaction score of 3.4 (on a 4-point scale) in months 2 and 3 also exceeded the corresponding benchmark standards. Expert ratings of fidelity of clinician delivery of group therapy treatment according to the manualized guidelines exceeded the benchmark of 3.0 on 4-point scales at 3 sites, with marked improvement in the last pilot weeks at the 4th site.
Conclusions: Group therapy and cognitive remediation with a partner can be delivered through telementalhealth procedures, with careful design of procedures and real-time support to overcome technical barriers.
M. Killam, BA, R. Schutt, PhD, E Buelt, MD, J Choi, PsyD, F Crow, MD, J Delman, JD, S Eack, DSW, X Fan, MD, L. R. Golden, MA, R. Mesholam-Gately, PhD, K Mueser, PhD, S Pratt, PhD, L. Sandoval, PhD, M Santos, MSW, K Woodberry, PhD, M. Keshavan, MD
M. Keshavan, MD