A modified approach leads to better results for people with schizophrenia
Can we offer better care for our patients?
This simple question often drives research at CAMH, as health-care providers are motivated to find ways to improve upon existing treatments. One example is a treatment for schizophrenia called cognitive adaptation training (CAT). Initially developed at the University of Texas, CAT has been shown to improve the lives of people with schizophrenia.
The CAT model addresses the aspects of schizophrenia that typically are not well addressed with standard treatments, including difficulties with memory and attention, keeping up momentum or staying organized.
The treatment involves a CAT clinician and a person with schizophrenia meeting at the client’s home or in a community setting for an hour or more every week for nine months. The two work toward goals set out by the client, which could range from finding volunteer or paid work opportunities to organizing their home or taking part in social or leisure activities. The CAT clinician provides strategies and easy-to-use tools, such as reminder signs, calendars or alarm clocks, to help a client in their own environment.
Research showed that CAT worked, but it required a great deal of clinicians’ time. Also, the benefits that clients experienced did not last after the weekly meetings ended.
Together, researchers at CAMH and the University of Texas decided to study a modified version of CAT that was shorter and less labour-intensive, and with a goal of maintaining improvements. Twenty-four people took part in this pilot study.
The modified CAT study involved pairing a clinician with a person with schizophrenia for four months of intensive cognitive adaptation training, versus nine months in the original model. Over these four months, the pair met for at least an hour a week to work toward the client’s goals.
After this initial stage, the client’s case manager provided followup care for five months. As part of the study, the case manager had received training in providing CAT. The case manager met with the client once or twice a month, as well as by phone or at the clinic as needed.
The study showed that this modified model helped people continue to make progress toward their goals. “We observed truly remarkable improvements in the lives of people with some of the most challenging forms of the illness,” says CAMH’s Dr. Sean Kidd
. (You can see the results of this pilot project in the journal Schizophrenia Research
The shorter, more sustainable approach could make this beneficial treatment available to more people.
Since completing the study, the research team has trained more than 80 health-care professionals throughout CAMH and at other organizations in providing CAT as a treatment and has developed a regional CAT community of practice for health-care professionals.
CAT is one example of how approaches to mental health care are constantly evolving through research to provide clients with ever-improving care.