Limits...
Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial.

Granholm E, Holden JL, Sommerfeld D, Rufener C, Perivoliotis D, Mueser K, Aarons GA - Trials (2015)

Bottom Line: Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning.Primary analyses will be conducted using linear mixed-effects models for continuous data.Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs.

View Article: PubMed Central - PubMed

Affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. egranholm@ucsd.edu.

ABSTRACT

Background: Schizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies.

Methods/design: For the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives.

Discussion: Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits.

Trial registration: ClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014.

No MeSH data available.


Related in: MedlinePlus

Model of functional outcome in schizophrenia
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4590698&req=5

Fig1: Model of functional outcome in schizophrenia

Mentions: Interventions guided by research on factors that contribute to functional impairment in schizophrenia are needed. In this section, we briefly describe a model of functional outcome in schizophrenia (see Fig. 1) that includes the determinants of functional impairment targeted by CBSST, including skill competence and defeatist performance attitudes. It is well established that neurocognitive deficits are associated with functional impairment in schizophrenia [3, 4], but the relationship between neurocognitive impairment and real-world outcome in schizophrenia is mediated by several factors, such as functional skill capacity or the ability to perform the skills needed to function in the community (e.g., grocery shopping, writing checks to pay bills, using an automated teller machine) [5–8]. Functional skills like interpersonal communication skills can be systematically trained using social skills training (SST), which is one key element of the CBSST program.Fig. 1


Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial.

Granholm E, Holden JL, Sommerfeld D, Rufener C, Perivoliotis D, Mueser K, Aarons GA - Trials (2015)

Model of functional outcome in schizophrenia
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590698&req=5

Fig1: Model of functional outcome in schizophrenia
Mentions: Interventions guided by research on factors that contribute to functional impairment in schizophrenia are needed. In this section, we briefly describe a model of functional outcome in schizophrenia (see Fig. 1) that includes the determinants of functional impairment targeted by CBSST, including skill competence and defeatist performance attitudes. It is well established that neurocognitive deficits are associated with functional impairment in schizophrenia [3, 4], but the relationship between neurocognitive impairment and real-world outcome in schizophrenia is mediated by several factors, such as functional skill capacity or the ability to perform the skills needed to function in the community (e.g., grocery shopping, writing checks to pay bills, using an automated teller machine) [5–8]. Functional skills like interpersonal communication skills can be systematically trained using social skills training (SST), which is one key element of the CBSST program.Fig. 1

Bottom Line: Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning.Primary analyses will be conducted using linear mixed-effects models for continuous data.Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs.

View Article: PubMed Central - PubMed

Affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. egranholm@ucsd.edu.

ABSTRACT

Background: Schizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies.

Methods/design: For the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives.

Discussion: Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits.

Trial registration: ClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014.

No MeSH data available.


Related in: MedlinePlus