Does Adding Social Cognitive Remediation Therapy to Neurocognitive Remediation Therapy Improve Outcomes in Young People With a Severe Mental Illness?-The Advantage Trial.

Introduction: Cognitive impairments are a common and significant issue for young people with a severe mental illness. Young people with schizophrenia, bipolar disorder and major depression all experience significant cognitive problems that impede their ability to return to work or study. These neurocognitive problems are frequently exacerbated by social cognitive deficits that interfere with their ability to integrate into the community and understand the social and emotional nuances about them. This study aimed to assess if the addition of a social cognitive remediation treatment to a neurocognitive remediation therapy improved functional outcome. Methods: Five youth mental health services were trained in both the Neuropsychological Educational Approach to Remediation (NEAR) and the Social Cognition and Interaction Training (SCIT) treatments. Participants were randomised between receiving either NEAR + SCIT or NEAR + treatment as usual (TAU) over a 20-week period, with all participants receiving the NEAR treatment first. Symptoms, neurocognition, social cognition and functioning were examined at baseline, end of treatment and at 3 months follow-up and compared between the two arms of the study. The primary outcome was function. Results: Thirty-nine participants were randomised to treatment (Schizophrenia spectrum = 28, Bipolar disorder = 7, Major Depression = 2). The trial was curtailed by Covid-related service restrictions. There was an overall significant improvement in function over time with a trend towards a greater improvement in the NEAR + SCIT arm. No changes in symptoms, neurocognitive or social cognitive measures were seen. While 74% completed treatment only 49% agreed to follow up at 3 months affecting our ability to interpret the findings. Attrition did not differ by arm. Conclusions: In a pragmatic, service-based research project, treatment aimed at improving cognition enhanced functional outcome in young people with a range of severe mental illnesses. There was a trend towards improved function in young people who had a combined NEAR + SCIT approach. Clinical Trial Registration: Identifier: ACTRN12622000192785.

Recovery Assessment Scale-Domains and Stages: Measurement capacity, relevance, acceptability and feasibility of use with young people.

AIM: The Recovery Assessment Scale-Domains and Stages (RAS-DS) is a self-rated measure of mental health recovery. While this instrument has demonstrated good measurement properties and acceptability to clinicians and consumers in adult mental health services, it has not been evaluated in the context of youth-focused mental health services. This study was established to evaluate the measurement properties, feasibility and acceptability of the RAS-DS in a youth mental health service context. METHODS: Young people accessing a youth mental health service were invited to complete the RAS-DS and both young people and clinicians provided feedback about its usefulness. Analyses of the measurement properties of the RAS-DS were completed using Rasch analysis. Usability feedback was analysed using descriptive statistics and constant comparative analysis. RESULTS: Fifty-eight consumer-clinician dyads participated. Analyses revealed that items on the RAS-DS generally demonstrated good fit with the expectations of the Rasch model and clinician and consumer feedback was generally positive. Ninety-one percent of young people completed the RAS-DS in less than 15 minutes. Thirty-four percent of young people had measure scores above the level of the "hardest" item on the RAS-DS, suggesting that measurement precision is lower for individuals at more advanced stages of recovery. CONCLUSIONS: This study demonstrates that the RAS-DS has acceptable measurement properties and was acceptable to young people and clinicians. Future research should explore the use of the RAS-DS by young people in other contexts as well as explore whether additional items could be added to capture the later stages of recovery for young people.

Routine outcome measurement in mental health: feasibility for examining effectiveness of an NGO.

OBJECTIVE: The aim of this study was to examine the feasibility of using routine public mental health outcome data to measure the effectiveness of a non government organization (NGO), specifically Pioneer Clubhouse. METHOD: We retrieved data from the NSW Mental Health Outcomes and Assessment Tools (MH-OAT) database, for 31 participants who joined Pioneer Clubhouse, NSW, in 2007. Data were also sought for 31 matched control participants from within the same Area Health Service. Data collected from the adult MH-OAT instruments, Health of the Nation Outcome Scales (HoNOS), Kessler-10 (K-10) and Abbreviated Life Skills Profile-16 (LSP-16), was retrieved for 13 weeks prior to joining date and compared with 13 weeks of data 6 months after joining. RESULTS: Twenty-four Clubhouse members were registered in the MH-OAT database. Only one of the 24 participants had data for both time periods requested. MH-OAT data collection was insufficient to allow their use for measuring effectiveness of a NGO. CONCLUSION: Despite the National Mental Health Plan emphasis, and extensive and expensive support for routine data collection in public mental health services, such data collection has been unsuccessful. We discuss possible reasons for this.