In-person vs. Remote Wellness Support
Condition: Depressive Disorder, Major; Bipolar Disorder; Schizo Affective Disorder; Schizophrenia
MeSH terms: Schizophrenia; Depressive Disorder; Bipolar Disorder; Mood Disorders; Depressive Disorder, Major; Psychotic Disorders
Study type: Interventional

Summary: 
      The study team will use components of the Reach, Effectiveness, Adoption, Implementation,
      Maintenance (RE-AIM) framework to compare Cognitive Adaptation Training (CAT) to Remotely
      delivered Cognitive Adaptation Training (R-CAT) 1-9 within a managed care organization (MCO),
      targeting members with serious mental illness (SMI) needing assistance with the regular
      taking of medication.
    

Detailed description: 
      Individuals choosing or assigned to R-CAT will continue treatment as usual with their health
      care team and R-CAT will be added. R-CAT is a remotely delivered version of CAT focused on
      medication adherence using a series of manual-driven compensatory strategies and
      environmental supports (signs, checklists, electronic cueing devices) based upon a
      streamlined assessment of executive function impairment and barriers to habit formation
      including forgetfulness, difficulties in problem-solving, disorganization, apathy or
      amotivation, disinhibition. and home environment. Initial R-CAT goals are to 1) ensure that
      medications listed as prescribed are available 2) to assess current cognitive, behavioral and
      environmental facilitators and barriers to habit-formation 3) to set up customized CAT
      supports to address the barriers and use facilitators to build habits to take medication.
      Rare home visits may occur if issues cannot be resolved remotely. Based upon the pilot, the
      study team don't anticipate any more than 5-10% of individuals to need face-to-face visits.
      No one had home visits as part of the pilot intervention. A structured R-CAT treatment note
      with places for pictures of CAT interventions is used for home visits. Support and reminder
      calls use a brief checklist modified from the Healthy Habits Program to address issues in use
      of supports, placement of supports and habit formation. Examples of CAT interventions to
      promote taking medication regularly appear above. All home visits and phone calls will be
      audio-taped (with consent) for quality assurance.
    

Intervention name(s): CAT; R-CAT
Intervention type(s): Behavioral; Behavioral
Intervention description(s): An evidence-based psychosocial treatment using environmental supports such as signs, alarms, pill containers, and the organization of belongings established in a person's home on weekly visits to cue adaptive behaviors and establish healthy habits.; An evidence-based psychosocial treatment using environmental supports such as signs, alarms, pill containers, and the organization of belongings established in a person's home using remote weekly visits to cue adaptive behaviors and establish healthy habits.
Other intervention name(s): Cognitive Adaptation Training; Remote Cognitive Adaptation Training
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized parallel design
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Serious mental illness