Award Title: Evaluating remote delivery of Cognitive Remediation for people severe mental health conditions
Funder: Department of Health and Social Care

Abstract: Background: Cognitive impairment is one of the main predictors of poor functioning and recovery in people with severe mental health conditions (SMI). Cognitive remediation (CR), a psychological treatment, addresses these cognitive problems in people with SMI and meta-analytic studies suggest that CR benefits both cognition and functioning. Successful NHS implementation of CR could improve recovery trajectories and reduce the disease burden on service users, services, and society. The ECLIPSE Programme Grant for Applied Research (PGfAR) evaluated NHS implementation in psychosis services and developed capacity for routine therapy delivery across the NHS. One clear result from this and other studies is the importance of a therapist for achieving benefit.  Aim: To expand the work of ECLIPSE by increasing access to CR benefit by evaluating therapist-supported remote CR. This involves developing training resources for remote delivery for both service users and therapists to support remote CR delivery and evaluate implementation feasibility and acceptability in NHS services.  Objectives: 1) to develop resources for therapy delivery and resources for service users to overcome the digital divide so remote CR can be trained and delivered on digital technology platforms (WP1); 2) to evaluate the feasibility and acceptability of the therapy procedures (WP2); 3) to estimate resource utilisation for this approach (WP3).  Work plan:  We have already had service user support in developing this proposal but in addition in Step 1 we will recruit a dedicated service user advisory panel to support the adaptation of therapy procedures and development of training resources for digital inclusion. In Step 2 we will conduct an acceptability and feasibility evaluation of the remote CR procedures using a case series design including 25 participants. All participants will be assessed before and after therapy with measures assessing personal goals, functioning and cognition as well as quality of life and service utilisation. Participants will be invited to take part in exit interviews to explore their therapy experience in detail. In Step 3 we will conduct acceptability and feasibility analyses and report on indications of therapy usefulness and cost-benefit. The programme will deliver a therapy manual, video training resources for service users and augment existing CR therapist training procedures with recommendations for technology use and best practice for remote delivery.  Timeframe: This programme will be completed in 12 months.  Impact: The resources developed and evaluated in this programme will allow NHS services to expand the implementation of CR. This will be particularly beneficial for more rural mental health service providers and for service users for whom travelling to the clinic represents a barrier to accessing care. The cost estimation will provide information on the cost of the remote CR method.  Dissemination: The therapy manual, video training resources and recommendations for best practice will be widely available to the NHS and incorporated into the existing training platform. The feasibility and acceptability results will be disseminated via peer review publications and to service user and staff participants.

Lay Abstract: Background: Many people with a severe mental health condition experience cognitive problems. These include difficulties in paying attention to a conversation, remembering or learning new information, scheduling and organising tasks.  Cognitive difficulties have a severe and negative impact on functioning and recovery in this group. Cognitive Remediation (CR) is a therapy targeting cognitive difficulties and supporting functional recovery in people with severe mental health conditions. This approach is increasingly recommended and included in clinical guidelines.  Our previous work: We recently completed a NIHR Programme Grant for Applied Research evaluating ways in which CR can be used in NHS early psychosis services. This research also developed capacity for this therapy to be delivered more routinely across the NHS. One aim of this research was to compare distinct CR delivery methods with different levels of therapist input including individual one-to-one CR and CR delivered in a group format. Crucially the study results showed that both group and individual CR can improve service users  recovery goals. However, restrictions on face-to-face contact limit their feasibility, and like other psychological therapies, CR will need to be adapted for remote delivery. This requires procedures and training resources to be co-developed with service users and technologies tested.  Our aims: There is no evidence suggesting that delivering CR remotely is feasible or even acceptable to people with severe mental health conditions. This proposal will expand on our previous work by evaluating therapist supported remote CR. This will be the same therapy format but delivered entirely using remote digital platforms using video meetings and remote monitoring of a service user s laptop.  Work plan: We will develop procedures and training for therapist supported remote CR delivery and test their acceptability, ease of use and feasibility. We will do this with the support of a service users advisory panel to guide our decisions. Our therapy evaluation will include twenty-five individuals with a wide range of severe mental health conditions. We will also include those with long-term conditions identified as needing this intervention the most by clinical guidelines in England and Scotland.  Impact: Therapist supported remote delivery of CR will be important during times when social distancing measures are imposed. However, developing a therapeutic approach that is acceptable and feasible will also allow wider therapy dissemination. One finding from our previous research is that the therapist input is crucial to achieve improvements. Offering independent therapy may not be a good alternative option for those who find it difficult to attend appointments or must travel a long way to reach the clinic. For these individuals, therapist supported remote CR may be a more suitable alternative.

Research Activity Codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health Categories: MENTAL HEALTH