Trial Outcomes & Findings for A Study of Cognitive Adaptation Training in Inpatient Forensic Environments (NCT NCT04294719)

Last Updated: 2023-01-26

Results Overview

Room organization will be measured by ratings on the Clutter Image Rating Scale (CIRS; Frost et al., 2008). The CIRS is a 9-picture visual analogue scale used to quantify and standardize the amount of clutter in 3 different living spaces (kitchen, living room, and bedroom). Min is 1 and Max is 9. Higher ratings indicate more clutter. For this project, only the bedroom rating scale will be utilized. The CIRS is used to measure the severity of clutter in compulsive hoarding. Before and after photos will be taken of each participant's room. These photos will be rated by 2 blinded student investigators with the mean rating taken.

Recruitment status

COMPLETED

Target enrollment

24 participants

Primary outcome timeframe

Baseline

Results posted on

2023-01-26

Participant Flow

Participant milestones

Participant milestones
Measure	Inpatient Clients Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.
Overall Study STARTED	19
Overall Study COMPLETED	18
Overall Study NOT COMPLETED	1

Reasons for withdrawal

Reasons for withdrawal
Measure	Inpatient Clients Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.
Overall Study Withdrawal by Subject	1

Baseline Characteristics

A Study of Cognitive Adaptation Training in Inpatient Forensic Environments

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.
Age, Continuous	38.1 years STANDARD_DEVIATION 10.6 • n=93 Participants
Sex: Female, Male Female	1 Participants n=93 Participants
Sex: Female, Male Male	17 Participants n=93 Participants
Race/Ethnicity, Customized Black	12 Participants n=93 Participants
Race/Ethnicity, Customized Caucasian	6 Participants n=93 Participants
Education Less than High School	2 Participants n=93 Participants
Education Some High School	5 Participants n=93 Participants
Education High School	5 Participants n=93 Participants
Education Some College	2 Participants n=93 Participants
Education College Diploma	2 Participants n=93 Participants
Education Some University	1 Participants n=93 Participants
Education Undergraduate Degree	1 Participants n=93 Participants
Primary Diagnosis Schizophrenia	13 Participants n=93 Participants
Primary Diagnosis Schizoaffective Disorder	2 Participants n=93 Participants
Primary Diagnosis Schizoaffective Bipolar	3 Participants n=93 Participants
Secondary Diagnosis Antisocial Personality Disorder	4 Participants n=93 Participants
Secondary Diagnosis Alcohol Dependence	5 Participants n=93 Participants
Secondary Diagnosis Borderline Intelligence	1 Participants n=93 Participants
Secondary Diagnosis Cannabis Use	5 Participants n=93 Participants
Secondary Diagnosis Paraphilia Not Otherwise Specified	1 Participants n=93 Participants
Secondary Diagnosis Substance Abuse	1 Participants n=93 Participants
Secondary Diagnosis Substance Use	4 Participants n=93 Participants
Secondary Diagnosis None	1 Participants n=93 Participants
Concurrent Diagnosis Yes	16 Participants n=93 Participants
Concurrent Diagnosis No	2 Participants n=93 Participants
Dual Diagnosis Attention Deficit Hyperactivity Disorder	2 Participants n=93 Participants
Dual Diagnosis ADHD and Intellectual Disability	1 Participants n=93 Participants
Dual Diagnosis Intellectual Disability	2 Participants n=93 Participants
Dual Diagnosis None	13 Participants n=93 Participants
Not Criminally Responsible/Unfit to Stand Trial Status NCR	18 Participants n=93 Participants
Not Criminally Responsible/Unfit to Stand Trial Status UST	0 Participants n=93 Participants
Violent Offense Yes	15 Participants n=93 Participants
Violent Offense No	3 Participants n=93 Participants
Approximate Age of First Episode	21.3 years STANDARD_DEVIATION 7.7 • n=93 Participants
Approximate Length of Illness (Years)	16.8 years STANDARD_DEVIATION 10.5 • n=93 Participants
Length of Stay (NCR Data-Treatment Start Date)	2770.4 days STANDARD_DEVIATION 2118.8 • n=93 Participants

PRIMARY outcome

Timeframe: Baseline

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Clutter Image Rating Scale (CIRS) - Blind-rated	2.28 score on a scale Standard Deviation .575	—	—

PRIMARY outcome

Timeframe: 4-Weeks Post-Intervention

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Clutter Image Rating Scale (CIRS) - Blind-rated	1.56 score on a scale Standard Deviation .616	—	—

PRIMARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Clutter Image Rating Scale (CIRS) - Blind-rated	1.44 score on a scale Standard Deviation .511	—	—

PRIMARY outcome

Timeframe: Baseline

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Clutter Image Rating Scale (CIRS) - Patient-rated	1.94 score on a scale Standard Deviation .80	—	—

PRIMARY outcome

Timeframe: 4-Weeks Post-Intervention

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Clutter Image Rating Scale (CIRS) - Patient-rated	1.56 score on a scale Standard Deviation .71	—	—

PRIMARY outcome

Timeframe: Baseline

Personal hygiene will be measured by scores on the Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, \& Parker, 1989). The LSP consists of 39 clinician-rated questions on a four-point scale and measures various aspects related to daily life activities: self-care; non-turbulence; social contact; communication; responsibility. For this project, only the self-care ratings from the full LSP-39 will be completed by service providers (items 10, 12, 13, 14, 15, 16, 23, 24, 26, and 30). While each item consists of 4 responses, the content of each response is different for each item. Overall, higher scores indicate better functioning. Max total score is 40. Min total score is 10. Current inpatient research on the use of CAT also uses this scale as a primary measure of the effectiveness of CAT. Scores will be obtained from the nursing staff not directly involved in the delivery of the finCAT intervention.

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Life Skills Profile (LSP) - Self-Care Subscale	23.56 score on a scale Standard Deviation 5.52	—	—

PRIMARY outcome

Timeframe: 4-Weeks Post-Intervention

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Life Skills Profile (LSP) - Self-care Subscale	24.00 score on a scale Standard Deviation 5.64	—	—

PRIMARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Life Skills Profile (LSP) - Self-care Subscale	24.61 score on a scale Standard Deviation 4.79	—	—

PRIMARY outcome

Timeframe: Baseline

Goal Attainment Scaling (GAS) will be employed as a sensitive measure of progress on individually defined goals. Goal attainment scaling involves the setting of 3-5 goals, each operationalized on a 5-point scale. Min is -2. Max is 2. Higher scores indicate greater attainment of the goal. Goals are individualized to the client and assessment of progress is determined through consensus of the clinician and case manager.

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 1	-1.00 score on a scale Standard Deviation .000	—	—

PRIMARY outcome

Timeframe: 4-Week Post-Intervention

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 1	1.06 score on a scale Standard Deviation .984	—	—

PRIMARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 1	0.81 score on a scale Standard Deviation .889	—	—

PRIMARY outcome

Timeframe: Baseline

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 2	-1.00 score on a scale Standard Deviation .000	—	—

PRIMARY outcome

Timeframe: 4-Week Post-Intervention

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 2	1.11 score on a scale Standard Deviation 1.13	—	—

PRIMARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Goal Attainment Scaling (GAS) - Goal 2	0.78 score on a scale Standard Deviation .878	—	—

SECONDARY outcome

Timeframe: Baseline

The attitudes of the team members towards finCAT will be measured using the Evidence-Based Practice Attitude Scale (EPBAS; Aarons, 2004) adapted to specifically target attitudes towards CAT. The EPBAS is a self-report questionnaire consisting of 36 items measured on a 5-point Likert scale ranging from 0 ('Not at all') to 4 ('To a very great extent') and consists of 12 subscales. Maximum is 4. Minimum is 0. Higher scores indicate a more open attitude towards new types of therapy, interventions or treatments including manualized therapy.

Outcome measures

Outcome measures
Measure	Inpatient Clients n=15 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses n=12 Participants Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Evidence-Based Practice Attitude Scale (EBPAS)	3.15 score on a scale Standard Deviation .35	2.83 score on a scale Standard Deviation .70	—

SECONDARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=15 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses n=12 Participants Nursing staff working on the units where finCAT was administered.	Nurses Nursing staff working on the units where finCAT was administered.
Evidence-Based Practice Attitude Scale (EBPAS)	3.22 score on a scale Standard Deviation .24	2.92 score on a scale Standard Deviation .55	—

SECONDARY outcome

Timeframe: Baseline

The therapeutic alliance on the unit will be measured by clinician and client ratings on the Essen Climate Evaluation Schema (Essen CES; Schalast et al., 2008). The Essen CES is a 15-item questionnaire measured on a 5-point Likert scale ranging from 'Not at all' to 'Very Much' and consists of three subscales: (1) Patient's Cohesion, (2) Experienced Safety, and (3) Therapeutic Hold. For this study, client and clinician ratings on the Therapeutic Hold and Experienced safety subscales will be collected. For each sub-scale, the max is 20 and minimum is 0. Higher scores indicate greater experienced safety and therapeutic hold.

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses n=15 Participants Nursing staff working on the units where finCAT was administered.	Nurses n=12 Participants Nursing staff working on the units where finCAT was administered.
Essen Climate Evaluation Schema (Essen CES) Experienced Safety	13.46 score on a scale Standard Deviation 3.60	10.94 score on a scale Standard Deviation 3.28	10.67 score on a scale Standard Deviation 4.55
Essen Climate Evaluation Schema (Essen CES) Therapeutic Hold	12.85 score on a scale Standard Deviation 4.36	15.19 score on a scale Standard Deviation 3.39	14.67 score on a scale Standard Deviation 2.94

SECONDARY outcome

Timeframe: 2-Month Follow-Up

Outcome measures

Outcome measures
Measure	Inpatient Clients n=18 Participants Have a chart diagnosis of a schizophrenia spectrum illness, capacity to consent or availability of a substitute decision-maker to consent with the assent of the participant and is residing on a CAMH inpatient forensic unit (general security) Cognitive Adaptation Training (CAT): Cognitive Adaptation Training (CAT) is a standardized implementation of environmental supports for improving adaptive functioning including medication adherence, grooming, and daily activities in patients with schizophrenia. Environmental supports (signs, checklists) are manual-driven and grounded upon an assessment of neurocognitive function and behaviour. Assessment results yield one of six CAT classifications (Apathy/Poor Executive Functioning, Disinhibited/Poor EF, Mixed/Poor EF, Apathy/Fair EF, Disinhibited/Fair EF, Mixed/Fair EF).The goal will be to improve organization and self-care, modifying the intervention to be more relevant for an inpatient setting. Once an individual's CAT classification has been determined, strategies for specific functional problems are chosen from a series of tables. CAT interventions are maintained in the client's living space during weekly visits. CAT clinicians will encourage team members to assist with the reinforcement of CAT tools and strategies.	Nurses n=15 Participants Nursing staff working on the units where finCAT was administered.	Nurses n=12 Participants Nursing staff working on the units where finCAT was administered.
Essen Climate Evaluation Schema (Essen CES) Experienced Safety	13.15 score on a scale Standard Deviation 3.56	11.06 score on a scale Standard Deviation 3.17	12.17 score on a scale Standard Deviation 2.48
Essen Climate Evaluation Schema (Essen CES) Therapeutic Hold	12.77 score on a scale Standard Deviation 4.68	15.25 score on a scale Standard Deviation 2.89	15.83 score on a scale Standard Deviation 1.17

SECONDARY outcome

Timeframe: 2 months after month of service implementation

The attitudes of the team members towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT, and perceptions of team tension or conflict arising or abating during the implementation of finCAT. Small focus groups with healthcare providers will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: 2 months after month of service implementation

The attitudes of the participants towards finCAT will also be measured using a qualitative feedback form created for this study. Questions will target attitudes towards finCAT, perceptions of the impact of finCAT. Individual interviews with interested clients will be facilitated by student investigators. Interviews will be audio-recorded and transcribed verbatim.

Outcome measures

Outcome data not reported

Adverse Events

Inpatient Clients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Courtney Brennan

Centre for Addiction and Mental Health

Phone: 4165358501

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place