Building Resilience and Recovery through Enhancing Cognition and quality of LIfe in the early PSychosEs (ECLIPSE)

PATIENT and PUBLIC INVOLVEMENT We have already consulted service users and carers on treatment development and study design and will build on this to ensure active involvement in all aspects of the study. Most interventions rarely take account of either the views of patients or health care staff but this programme is different. We designed the studies to ensure continued involvement and will use their views in balancing recommendations on delivery. BACKGROUND Systematic reviews demonstrate cognitive remediation therapy (CRT) benefits1 with larger gains in younger than older patients with psychosis8. These benefits are in a diagnostic group with associated high levels of disability and NHS support throughout their lives. Interventions that improve recovery trajectories have the biggest impact if provided at the earliest opportunity within services offering other recovery opportunities. NHS benefit is not only based solely on intervention efficacy but also on the acceptability to those who provide and receive it. This is a key issue if treatment is to be cost-effective in practice. AIMS and OBJECTIVES The proposal investigates, in a novel framework of studies, the optimal method of providing CRT in EIS by assessing cost-effectiveness of alternative intervention methods by combining costs with monetary values of outcome using the net benefit approach. This will be considered alongside the views of services users and staff regarding the different modes of treatment implementation. Our objectives are: to measure feasibility; evaluate therapist training protocols; and assess preferences of staff and service users. We will evaluate factors that might impact implementation success such as organizational climate as well as explore treatment moderators that might help in tailoring individual treatments. CRT will be provided together with other services and we will explore the potential for boosting recovery outcomes with novel social cognition treatment. Finally, we will investigate how many people might benefit from such treatment and further explore factors that may affect benefits. RESEARCH PLAN WP1 – is a developmental phase which will devise satisfaction measures and preference domains using participatory methods and is service user led. Finally, we will investigate the organisational factors likely to affect implementation WP2 – develops a web-supported training programme for cognitive remediation therapists WP3 – investigates three different methods of providing CRT across ten EIS teams and will compare their outcomes with treatment as usual using a net benefit approach. The trial will stop an implementation arm at 12 months if it provides significantly poorer outcomes at greater cost than the other arms. WP4 – assesses the effects of different potential moderators of outcome to provide advice on tailoring treatment. DISSEMINATION and PROJECTED OUTPUTS We are proposing at least 20 publications throughout the programme (see Appendix p43) which disseminate information through peer review and to all relevant groups. We will provide a manual and multimedia web-available training for delivering therapy. Finally, we provide a guide to implementation of cognitive remediation for NHS managers. Many of these resources will aid other therapy implementation in NHS mental health services. Successful implementation has the potential to change the recovery trajectory of individuals with a first episode of psychosis but also provides guidance on large scale roll out to all mental health services where cognitive difficulties impact recovery and resilience. TEAM EXPERTISE The team has extensive expertise in developing, evaluating and translating therapy into practice. We have world class statistical and health economic support and, uniquely, expertise in service user involvement and implementation science. The team has managed applied programmes, large scale trials as well as