Cognitive adaptation training for forensic psychiatry inpatients with schizophrenia spectrum diagnoses

ABSTRACT

Cognitive deficits affect 70–75% of individuals with schizophrenia and significantly impact functioning. Cognitive Adaptation Training (CAT) is an evidence-based compensatory intervention that improves functioning through personalized environmental supports. Research has explored adaptations to CAT for specific contexts and sub-populations. The present study explored the feasibility and preliminary outcome data for CAT adapted for inpatient forensic psychiatry settings (finCAT). This study employed a single group mixed-method design collecting data at baseline, post-intervention, and 2-months follow-up. Forensic psychiatry inpatients with schizophrenia spectrum diagnoses (N = 18) participated. Outcomes included room organization, self-care, goal attainment, and qualitative interviews with patients (n = 4) and staff (n = 4), as well as secondary measures of unit climate and clinician attitudes. Data analyses with repeated-measures ANOVA revealed a significant effect of time on blind-rated room organization, with significant improvements at post-intervention sustained during follow-up. There were no significant changes to self-care ratings or secondary measures. Qualitative themes identified included (1) improvement in patients’ self-care and organization; (2) clinicians’ increased awareness of the relationship between cognitive deficits and functional outcomes; (3) improvements beyond self-care and room organization; and (4) increased opportunities for interprofessional collaboration. These results support the feasibility of adapting CAT for inpatient forensic psychiatry settings.

KEYWORDS:

• Self-care
• organization
• forensic psychiatry
• cognitive adaptation training
• environment

Highlights

• Forensic psychiatry inpatients face longer durations of stay that make environmental interventions like Cognitive Adaptation Training feasible and potentially beneficial.

• Research on the use and potential adaptations of Cognitive Adaptation Training for inpatient settings is an emerging area of study.

• Baseline, post-intervention, and 2-month follow-up measures completed by patients and staff demonstrated the feasibility of a version of Cognitive Adaptation Training adapted for inpatient forensic psychiatry settings (finCAT). Sustained improvements were observed in patient room organization and perceived benefits of finCAT by both patients and staff.

Acknowledgments

This paper was made possible by prior research by and consultation on cognitive adaptation training from Dawn Velligan, Natalie Maples, and Lissette van Der meer.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Geolocation information

Toronto, Ontario, Canada.

Additional information

Funding

The authors have no funding to report.