1. CAT Intro Presentation UT Health San Antonio, Department of Psychiatry, Division of Community Recovery, Research and Training

2. Overview Symptom and cognitive challenges in serious mental illness
How cognitive problems relate to community functioning
How Cognitive Adaptation Training (CAT) can make a difference
CAT Training
International Center of Excellence
Motivational Interviewing and CAT

3. Serious Mental Illness: Challenges related to outcome
Behavioral Challenges
Amotivation
Decreased activity
Social withdrawal
Substance Use
Insomnia
Psychosis
Delusions
Hallucinations
Disorganized speech/behavior
Community Functioning/Behavior
Work/School
Interpersonal relationships
Self-care/ADLs
Medication Adherence
Cognitive Challenges
Attention
Memory
Executive functions
Psychomotor Speed
Mood and Emotional Challenges
Depression
Mania
Anxiety

4. Understanding Cognitive Challenges
Attention
Memory
Information-processing/psychomotor speed
Executive functions
Gold JM and Harvey PD Psychiatric Clin North Am, 1993; 16: ;
Maples & Velligan, 2007

5. Executive Functions Formulate plans for goal directed behavior
Sequence behavior and thought
Maintain goal-directed-action in the face of distraction
Inhibit irrelevant or inappropriate behavior

6. Cognitive Functioning Predicts Real-World Outcomes
Executive
Function
Attention
Memory
Psychomotor
Speed
Daily Living Skills
Social
Function
Work
Green MF. Am J Psychiatry, 1996; 153:
Velligan et al., Schiz Res, 1997; 25: 21-31

7. Cognitive Functioning Predicts Real-World Outcomes
Executive
Function
Attention
Memory
Psychomotor
Speed
Daily Living Skills
Social
Function
Work
CAT
Environmental Supports
Green MF. Am J Psychiatry, 1996; 153:
Velligan et al., Schiz Res, 1997; 25: 21-31

8. Cognitive Adaptation Training (CAT)
CAT is a manualized list of environmental supports such as signs, calendars, checklists and the reorganization of belongings designed to get around problems with cognitive functions and improve success in everyday behaviors
Delivered in the home environment – typically weekly
Is evidence-based
Uses a motivational strengths perspective to facilitate a person’s initiatives and independence
Treatment is based upon how the person thinks and behaves
Level of executive function
Type of behavior exhibited (apathy, disinhibition)

9. Areas for CAT Intervention
Areas of Intervention
Areas for CAT Intervention
Bathing
Laundry
Dressing
Grocery Shopping
Dental Hygiene
Transportation
Orientation
Leisure Skills
Work/Vocational Skills
Toileting
Social Skills, Communication and Telephone Use
Housekeeping/Care of Living Environment
Eating, Nutrition and Cooking
Money Management/Budgeting
Medication Management
Coping Skills
I. What is Cognitive Adaptation Training?
II. The Four Principles of Cognitive Adaptation Training
III. CAT Assessments
IV. CAT Intervention Strategies: Part I
V. CAT Intervention Strategies: Part II
VI. Differences Between CAT and Other Treatments
VII. Introduction to CAT – A Review

10. Care of Living Environment
I. What is Cognitive Adaptation Training?
II. The Four Principles of Cognitive Adaptation Training
III. CAT Assessments
IV. CAT Intervention Strategies: Part I
V. CAT Intervention Strategies: Part II
VI. Differences Between CAT and Other Treatments
VII. Introduction to CAT – A Review

11. Orientation I. What is Cognitive Adaptation Training?
II. The Four Principles of Cognitive Adaptation Training
III. CAT Assessments
IV. CAT Intervention Strategies: Part I
V. CAT Intervention Strategies: Part II
VI. Differences Between CAT and Other Treatments
VII. Introduction to CAT – A Review

12. Medication – Let’s make it easier
Decreasing the number of steps needed to take medication increases the likelihood that it will be taken (Apathy)
Prompting the likelihood medication will be taken (Disinhibition)
Organization to address executive challenges
Did I take
my meds
today?

13. Promoting healthy lifestyles to address medical comorbidities

14. Daily Checklist – Multiple Areas
Mario's Daily Checklist
6/11
6/12
6/13
6/14
6/15
6/16
6/17
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Take Morning Meds
Take Shower
Use Deodorant
Use Mouth Wash
Take PM Meds
Change Clothes
Brush Teeth
Everyday
I. Basic CAT Interventions
II. Specific CAT Interventions
III. Problems and Pitfalls
IV. Implementing CAT – A Review

15. Daily Schedule

16. Differences Between CAT and Other Treatments or Case Management
Very little sitting down in CAT
Directive-offering suggestions, getting the person on board to move and do; prompting to help them do it themselves
Customizing the environment to compensate for thinking and motivational problems
A focus on empowerment and functioning-taking care of self and home, having leisure activities and friends, having meaningful daily activities
I. What is Cognitive Adaptation Training?
II. The Four Principles of Cognitive Adaptation Training
III. CAT Assessments
IV. CAT Intervention Strategies: Part I
V. CAT Intervention Strategies: Part II
VI. Differences Between CAT and Other Treatments
VII. Introduction to CAT – A Review

17. Center of Excellence
Established a Center of Excellence to offer training and sustainability of best practices for helping individuals with serious mental illness
Access for all agencies participating in the Texas Promoting Independence Initiative
Free training available to you, your agency and behavioral health affiliates
Login into TX Promoting Independence using your work . Let us know if you can’t login:

18. Resources Available to You

19. Resources Available to You
Check out clinician's corner! Lots of templates and other important resources
Resources Available to You