Problems with social skills and social and cognitive functioning (thinking skills) limit success in the community for persons with schizophrenia and related illnesses. These difficulties do not respond to drug therapies, but psychosocial interventions can result in meaningful improvement. Two types of intervention—Cognitive Enhancement Therapy (CET) and Social Skills Training (SST)—are most likely to be helpful, but we do not know which is more effective or whether some persons are more likely to benefit from one intervention rather than the other.
Outcomes: Comparing the effectiveness of CET and SST will provide results that help patients, providers, and policymakers choose between them. We will focus primarily on effects on community functioning and examine effects on cognitive functioning, social cognition, and social skills. We will also test whether CET works better for individuals who have more problems with cognition and for those who are younger. Patients who join the project will enroll in CET or SST for nine months. By the end of that period, we expect most participants will be doing better in the community (and stay better) and will have better thinking and socializing skills.
Why the project is important to patients: We have asked patients whether these programs have been helpful and received responses like: “The program was wonderful in helping me to become more independent.” “There’s a whole lot of things that you learn in classes as you go.” “I got more self-esteem, especially when we did the role-plays.” “It’s just amazing, it really is. When I go there, I feel really satisfied, like I’ve accomplished something.” The 18 mental health service sites that will deliver CET or SST in our project have heard from their own consumer boards and clinician meetings about the importance of learning how best to improve community functioning. At Hartford’s consumer- and family-led Family Resource Center, “ the topic of improving thinking and social skills is always on the forefront of agenda items .” Meetings about the project with clubhouse members, staff, and residents at the UMass site reported that “ in each meeting, interest in improving patient’s thinking and social skills in patients was expressed.” Another partner, the Metro Boston Recovery Learning Center, is focusing its peer-led recovery programming on improving social functioning. Our project will provide results that improve decisions about desirable interventions that patients and their advocates and clinicians are already seeking.
How patients and other stakeholder partners will help make the project successful: The Massachusetts Mental Health Center Consumer Advisory Board and our partners helped us design our project to maximize its success. We will form a Project Steering Committee including stakeholder representatives from our participating sites to ensure that this guidance continues. Our engagement coordinators, working with Steering Committee members, will in turn meet with the established boards, patient groups, and other stakeholders at each of our project sites to learn and share the progress of our project, help resolve implementation challenges, and contribute to implementation and dissemination of the results.
Other Clinical Interventions
Other Health Services Interventions
Training and Education Interventions
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.