title: Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Schizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies.
  
  
  METHODS
  For the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives.
  
  
  CONCLUSIONS
  Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014.
authors.affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. egranholm@ucsd.edu.|Department of Psychiatry, University of California, San Diego, CA, USA. egranholm@ucsd.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Granholm
authors.affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. jlholden@ucsd.edu.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Holden
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA, USA. dsommerfeld@ucsd.edu.
authors.forename: David
authors.initials: D
authors.lastname: Sommerfeld
authors.affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. Christine.Rufener@va.gov.|Department of Psychiatry, University of California, San Diego, CA, USA. Christine.Rufener@va.gov.
authors.forename: Christine
authors.initials: C
authors.lastname: Rufener
authors.affiliation: Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. dperivol@ucsd.edu.|Department of Psychiatry, University of California, San Diego, CA, USA. dperivol@ucsd.edu.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Perivoliotis
authors.affiliation: Boston University, Boston, MA, USA. mueser@bu.edu.
authors.forename: Kim
authors.initials: K
authors.lastname: Mueser
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA, USA. gaarons@ucsd.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D002140:California; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003156:Community Mental Health Services; D003695:Delivery of Health Care; D006801:Humans; D016014:Linear Models; D011569:Psychiatric Status Rating Scales; D012107:Research Design; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D012919:Social Behavior; D013997:Time Factors; D016896:Treatment Outcome