R-CAT: In-person vs. Remote Wellness Support
Study Details
Study Description
Brief Summary
The study team will use components of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to compare Cognitive Adaptation Training (CAT) to Remotely delivered Cognitive Adaptation Training (R-CAT) 1-9 within a managed care organization (MCO), targeting members with serious mental illness (SMI) needing assistance with the regular taking of medication.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Individuals choosing or assigned to R-CAT will continue treatment as usual with their health care team and R-CAT will be added. R-CAT is a remotely delivered version of CAT focused on medication adherence using a series of manual-driven compensatory strategies and environmental supports (signs, checklists, electronic cueing devices) based upon a streamlined assessment of executive function impairment and barriers to habit formation including forgetfulness, difficulties in problem-solving, disorganization, apathy or amotivation, disinhibition. and home environment. Initial R-CAT goals are to 1) ensure that medications listed as prescribed are available 2) to assess current cognitive, behavioral and environmental facilitators and barriers to habit-formation 3) to set up customized CAT supports to address the barriers and use facilitators to build habits to take medication. Rare home visits may occur if issues cannot be resolved remotely. Based upon the pilot, the study team don't anticipate any more than 5-10% of individuals to need face-to-face visits. No one had home visits as part of the pilot intervention. A structured R-CAT treatment note with places for pictures of CAT interventions is used for home visits. Support and reminder calls use a brief checklist modified from the Healthy Habits Program to address issues in use of supports, placement of supports and habit formation. Examples of CAT interventions to promote taking medication regularly appear above. All home visits and phone calls will be audio-taped (with consent) for quality assurance.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: Cognitive Adaptation Training (CAT) A home delivered adherence intervention used by managed care used to improve outcomes across multiple conditions. |
Behavioral: CAT
An evidence-based psychosocial treatment using environmental supports such as signs, alarms, pill containers, and the organization of belongings established in a person's home on weekly visits to cue adaptive behaviors and establish healthy habits.
Other Names:
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Active Comparator: Remote Cognitive Adaptation Training (R-CAT) A primarily remotely delivered workable adherence intervention used by managed care used to improve outcomes across multiple conditions. |
Behavioral: R-CAT
An evidence-based psychosocial treatment using environmental supports such as signs, alarms, pill containers, and the organization of belongings established in a person's home using remote weekly visits to cue adaptive behaviors and establish healthy habits.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Acceptance of intervention [Baseline to 6 months]
Proportion of subjects who dropped out of treatment
- Medication Adherence [Baseline to 6 months]
Adherence percent is calculated as the number of pills missing and presumed taken/ the number of pills prescribed for the time period X100. Monthly checks will be performed.
Secondary Outcome Measures
- Cost of treatment [Baseline to 6 months]
Cost to include mail, supports, provider time in visit, preparation time and mileage
- Pill count percent [Baseline to 6 months]
Medication possession ratio from prescription refill data
- Self-Report Habit Index (SRHI) [Baseline and at month 2, 4 and 6]
A 12-item scale assessing three proposed characteristics of habit;1) automaticity , 2) frequency, and 3) relevance to self-identity. Four items of this scale, items 2,3,5 and 8 represent the Self-Reported Behavioral Automaticity Index (SRBAI). Lower scores indicate greater habit strength and greater automaticity. A mean Habit score will be computed using the entire scale.
- Symptomatology [Baseline and at month 2, 4 and 6]
Change in symptoms assess by a trained rater using the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E). The scale is used to rate the subjects using 24 items, each to be rated in a 7-point scale of severity ranging from NA (not assessed), then 1-7, with 7 being the most severe. A total score reflects an overall level of symptomology, with 164, being the maximum score, with the most symptoms present.
- Functional Outcome [Baseline and month 2, 4 and 6]
Functional outcome will be rated using the Social and Occupational Functioning Scale (SOFAS).70 The SOFAS rates functioning on a scale from 0 to 100 based upon all the data collected in the assessment. Higher scores reflect better functional outcome.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Able to give informed consent.
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Between the ages of 18 and 65.
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Clinical Diagnosis of Major Depressive Disorder, Bipolar disorder, Schizophrenia, or Schizoaffective Disorder
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Receiving treatment with oral psychiatric medications.
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Have had a hospitalization or emergency department visit in the past year
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Have a Medication Possession Ratio (MPR) based upon electronic refill data below 80% at least 1 of the past 4 quarters with at least 1 psychiatric medication
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Responsible for taking their own medications
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Report on telephone prescreen call with researcher team that they have missed at least 2 doses of medication in the past 3 weeks, that they are willing to take medication and would like remote assistance to take medication more regularly
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Report on telephone prescreen call with research team that they have a stable living environment (individual apartment, family home, board and care facility) within the last three months and no plans to move in the next year
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Report on prescreen research call with research team that they have no plans to change their MCO in the next 12 months
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Have a working smart phone
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Able to understand and complete rating scales and assessments.
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Agree to home visits for intervention and to count pills and conduct assessments
Exclusion Criteria:
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Substance dependence within the past 2 months
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Currently being treated by an ACT team
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Documented history of violence or threatening behavior on initial assessment
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Receive home visits to assist with medication adherence
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Unable to complete baseline assessments
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | University of Texas Health Science Center - Department of Psychiatry | San Antonio | Texas | United States | 78229 |
Sponsors and Collaborators
- The University of Texas Health Science Center at San Antonio
- National Institute of Mental Health (NIMH)
Investigators
- Principal Investigator: Dawn Velligan, PhD, University of Texas Health at San Antonio
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HSC20200525H
- 1R56MH123797