Improving vocational outcomes in first-episode psychosis by addressing cognitive impairments using Cognitive Adaptation Training.
BACKGROUND
Cognitive Adaptation Training (CAT) uses compensatory strategies and environmental supports to support cognitive impairments and improve functioning. CAT may be useful for addressing vocational recovery in first-episode psychosis (FEP) because cognitive impairments are common and vocational recovery is a key goal of young people with FEP.


OBJECTIVE
To describe clinical observations and practice experience when delivering CAT with FEP clients and explore potential benefits via objective outcome measures for improving vocational outcomes.


METHODS
In this pilot study, five FEP participants received 9 months of CAT. Participant goals and functional needs and clinical observations were recorded. Formal measures of functioning, quality of life and motivation were independently administered pre- and post-intervention.


RESULTS
Vocational recovery (education, employment) was found to be a primary functional goal of FEP participants. Accordingly, CAT had a strong focus on vocational functioning, including functional domains required for successful work or educational outcomes, such as organization and planning, transportation and activities of daily living. Factors of clinical importance when delivering CAT with the FEP participants included cognitive heterogeneity, family involvement, flexibility in compensatory and environmental supports used, and experience of stigma. Improvements from baseline to post-intervention were observed on most measures, with the largest improvements seen in global functioning (including vocation), planning and organization, and quality of life.


CONCLUSIONS
CAT is an intervention that appears well suited to addressing vocational functioning in FEP, but larger controlled trials are needed.
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.|Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Kelly A
KA
Allott
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.|Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Eoin
E
Killackey
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.|Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Pamela
P
Sun
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.|Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Warrick J
WJ
Brewer
University of Texas Health Science Center, San Antonio, TX, USA.
Dawn I
DI
Velligan
D000203:Activities of Daily Living; D001315:Australia; D015928:Cognitive Behavioral Therapy; D060825:Cognitive Dysfunction / Q000628:therapy*; D004493:Education; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000534:rehabilitation* / Q000628:therapy*; D011788:Quality of Life; D055815:Young Adult
Cognition; compensatory strategies; environmental supports; schizophrenia; supported employment; vocational recovery