Incorporating Evidence-Based Cognitive Health Services In Large Systems of Care

Keypoint: OnTrackNY (OTNY) piloted its Cognitive Health Toolkit to implement cognitive health services in large systems of care.

The implementation of cognitive health services in large systems of care is possible with the help of training programs, quality assurance monitoring, and improvement activities, according to new research published in Schizophrenia Bulletin.

Although a wealth of research indicates a critical need for improved cognitive support services, there have been relatively few large-scale efforts that systematically address cognitive health needs in systems of care. To address this gap between research and practice, the current study aimed to evaluate and outline the necessary adaptations for effective implementation of cognitive health services in routine clinical settings within larger systems of care.

Investigators evaluated the implementation of cognitive health services within the OnTrackNY (OTNY) network of clinics that deliver Coordinated Specialty Care programs in New York state. OnTrack Central coordinated with local agencies and team leaders to govern the implementation process, and a Cognitive Health Toolkit was developed to facilitate the systematic assessment and integration of cognitive health interventions. The investigators evaluated the program via quality assurance monitoring from 2019 through 2022. The primary outcomes of interest included the use of the cognitive health screening tool, rates of self-reported and/or clinician-reported cognitive health needs, and participant interest in addressing cognitive health.

OnTrack Central provided 18 OTNY teams with the Cognitive Health Toolkit and these teams received training on screening participants for cognitive health needs and providing participants with relevant psychoeducation and skills training. In the first full year of implementation, the use of cognitive health screening tools was 53.9% – although these rates varied from 8.3% to 100% across the OTNY network.

Among participants who were screened in 2019, 95.5% were identified via self- report and/or clinician-report, with clinicians identifying cognitive health needs (68.4%) more frequently than participants (52.4%). Of those who were referred for the service based on an identified cognitive health need, 92.2% received a standardized neurocognitive assessment battery and 78.4% initiated cognitive remediation sessions.

The investigators noted that before the development and implementation of the Cognitive Health Toolkit, there was significant variability in the methods used to assess cognitive health needs across OTNY teams, and the methods used were not always evidence-based. Additionally, the investigators found that the organizational infrastructure of OTNY facilitated the implementation of a standardized approach for cognitive health services throughout the larger system.

The investigators concluded, “Our experience speaks to the need for a flexible, person-centered service model and a comprehen­sive, responsive system of implementation support to en­able the start-up, evolution, and improvement of cognitive health services within large systems of care.”

Note: This article originally appeared on Psychiatry Advisor