A Randomized Control Trial of Cognitive Compensatory Training (CCT) and Computerized Interactive Remediation of Cognition-Training for Schizophrenia (CIRCuiTS).

Background: Various modes of delivering cognitive remediation (CR) are effective, but there have been few head-to-head trials of different approaches. This trial aimed to evaluate the relative effectiveness of two different programmes, Cognitive Compensatory Training (CCT) and Computerized Interactive Remediation of Cognition-Training for Schizophrenia (CIRCuiTs). Methods: The study used a single-blind randomized, controlled trial to examine the efficacy and effectiveness of the two therapies. The study aimed to enroll 100 clinically stable patients between the ages of 18 and 65 years who had been diagnosed with a schizophrenia spectrum disorder. Participants were randomized to either the CCT or CIRCuiTs therapy groups. The primary outcome measures were neurocognition using the Brief Assessment of Cognition Scale (BACS) and the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS). The secondary measure was functional outcomes using the Social Functioning Scale (SFS). Results: There was no group difference in any of the outcome measures post-intervention or at follow-up. Both groups had a small improvement on their SSTICS scores between baseline (M = 30.52 and SD = 14.61) and post-intervention (M = 23.96 and SD = 10.92). Verbal memory scores as measured by list learning improved for both groups between baseline (z = -1.62) and 3-month follow-up (z = -1.03). Both groups improved on the token motor task between baseline (z = -1.38) and post-intervention (z = -0.69). Both groups had a decline in Symbol Coding scores between baseline (z = 0.05) and 3-month follow-up (z = -0.82). Discussion: This underpowered study found no difference in effect between the two approaches studied. If future studies confirm this finding, then it has implications for services where cost and lack of computer technology could pose a barrier in addressing the cognitive domain of schizophrenia spectrum disorders. The final sample size compromised the power of the study to conclusively determine a significant effect.

Implementing Introductory Training in Trauma-Informed Care Into Mental Health Rehabilitation Services: A Mixed Methods Evaluation.

OBJECTIVE: This paper describes the implementation of training in trauma-informed care (TIC) across a mental health rehabilitation service. METHOD: A mixed-methods approach was applied incorporating baseline measures of staff attitudes toward TIC, quantitative description of staff training participation, and semi-structured interviews of Team Leaders' views on the implementation of TIC. RESULTS: Fifty-five of 123 staff responded to the Organizational Change Readiness Assessment (OCRA) survey (44.7%). Training completion varied considerably between the eight rehabilitation teams (4.8-78%). Analysis of the Team Leader interviews identified four broad themes: The need to respect the person's life journey including the risk of re-traumatization; the importance of considering the context of implementing TIC training; TIC being an essential part of mental health care; and staff may also have trauma histories. CONCLUSIONS: Staff working in mental health rehabilitation are supportive of the need for TIC. The variable training uptake did not reflect the staff comments about the importance of TIC. The burden of adjusting mental health care delivery to COVID-19 restrictions was reported as a major influence on the uptake of training. Systematically implementing training in TIC is required but needs to be complemented by a structured organizational approach to aid embedding this approach into daily mental healthcare delivery.

Diary of a Mental Health Peer Worker: Findings From a Diary Study Into the Role of Peer Work in a Clinical Mental Health Setting.

Introduction: The importance of peer support workers in mental health care delivery has been extensively advocated for in mental health policy frameworks. However, there has been limited research examining the implementation of paid peer workers in clinical settings. This study explores the experience of paid peer support workers integrated within a clinically-operated community-based residential rehabilitation service for people diagnosed with a mental health disorder experiencing challenges living independently in the community. Methods: A general inductive approach was taken in the analysis of diaries completed by a newly employed peer workforce. These diaries focussed on what they viewed as significant interactions in fulfilling their role. Composite vignettes were generated to illustrate key themes. Findings: Thirty-six diaries were provided; these reported unplanned and spontaneously occurring interactions. Peer workers emphasized the importance of connecting with people while they were engaging in everyday activities as an opportunity for personal growth of the residents. The diaries also focussed on the peer workers' ability to connect and establish trust by sharing similar experiences with residents or family members. Peer workers also believed that they brought a different perspective than clinical staff and were able to refocus attention from clinical diagnoses and symptoms to other aspects of the resident's lives. Discussion: Peer support workers described their work as flexible, responsive, and adaptable to the resident's needs. They believed that their roles brought a different lens to interactions on the unit and fostered a more inclusive and personal way of working for the team. Conclusion: To ensure that peer workers can engage authentically with residents and family members, it is critical that the role and principles of peer work are valued and understood by all.