1. Cognitive Adaptation Training (CAT) as a nursing intervention in long-term residential patients
a multicenter cluster randomized controlled trial
A. P. M. Stiekemaa,b, L. van der Meera,b,c, P. J. Queed , M. Dethmersa, E. R. van den Heuvele, J. E. Redmeyera, K. Rietberga, M. Swartb,f, J. van Weeghelg, A. Alemanc,h, D. I. Velligani, R. A. Schoevers, R. Bruggemanb,j
aLentis Psychiatric Institute, Department of Rehabilitation, , Zuidlaren, the Netherlands
dLentis Psychiatric Institute, Department of Depression, PsyQ, Groningen, the Netherlands
c University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands
bUniversity of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands
eUniversity of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
fLentis Psychiatric Institute, Research Department, Groningen, the Netherlands
hUniversity of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, The Netherlands
gDijk en Duin Psychiatric Institute, Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
jUniversity of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
iDivision of Schizophrenia and Related Disorders, Department of Psychiatry, University of Texas, San Antonio, United States of America
Background
There is a need for evidence-based interventions that contribute to the functional recovery of long-term residential patients.
Cognitive Adaptation Training (CAT) improves functioning in outpatients with schizophrenia when CAT is given by psychologists1.
Aim
Evaluate the effect of CAT as a nursing intervention on functioning of SMI inpatients in long-term clinical care facilities.
Methods
Design: multicenter cluster RCT comparing CAT to Treatment As Usual (TAU).
Participants: SMI patients (mainly with psychotic disorders) in three long-term clinical care facilities in the Netherlands
Duration: one year, with follow-up at 15, 18, 21 and 24 months for the intervention group.
Primary outcomes: Multnomah Community Ability Scale (MCAS) and the Social and Occupational Functioning Scale (SOFAS).
Cognitive Adaptation Training
CAT is a compensatory approach that aims at creating new routines in the patients’ living environment through the use of environmental supports.
Common environmental supports are alarms, calendars, pill containers, and checklists.
For each patient, an individual CAT-plan is made based on behavior type, level of executive functioning and specific goals.
CAT aims at daily activities such as self care, housekeeping, transportation, money management, cooking, work performance, etc.
Experiences so far
Nurses
“CAT improved the relationship with the patient because we work together on the same goals”
“Working with CAT confronted me with my own hospitalisation”
“CAT gives practical guidance for supporting patients with common problems”
Patients
“It makes it easier for me to do the things that need to be done” (checklist with morning activities)
“When my room is less of a chaos, it is less of a chaos in my head” (reorganized location of belonings in the room)
“I now have more time in the morning to get ready for my work project” (voice alarm cueing getting started in the morning)
Implementation
CAT-plans and goals have been incorporated in the electronic patient dossier
During biweekly nurse meetings CAT-interventions are evaluated
Results are presented when all participants have
completed the 12-month assessments (early 2016).
Conclusion
CAT is feasible to be delivered by nurses to residential patients with SMI.
Based upon pilot results2 we expect functional outcome to be improved at and sustained after 12 months.
If CAT indeed is effective as a nursing intervention, it may be recommended to include CAT in the guidelines for SMI care and to implement CAT in standardized care.
* PANSS: Positive And Negative Syndrome Scale; CDSS: Calgary Depression Scale for Schizophrenia; MANSA: Manchester Short Assessment of Quality of Life; HoNOS: Health of the Nation Outcome Scale.
2Quee PJ, Stiekema APM, Wigman JTW, et al.(2014). Improving functional outcomes for schizophrenia patients in the Netherlands using Cognitive Adaptation Training as a nursing intervention - A pilot study. Schizophrenia Research, 158,120–125.
1Velligan DI, Bow-Thomas CC, Huntzinger, C., et al (2000). Randomized Control Trial of the Use of Compensatory Strategies to Enhance Adaptive Functioning in Outpatients with Schizophrenia. American Journal of Psychiatry, 157(8), 1317.