Implementing A Cognitive Screening Tool as Part of Routine Clinical Practice in Early Intervention for Psychosis...

Cognitive difficulties are a core feature of first-episode psychosis (FEP) and a key predictor of recovery. Despite this, cognitive screening is not routine in early intervention services (EIS) and limited research is available on the barriers and facilitators to its uptake. In this study, we explored front line staff's experiences with implementing a cognitive screener as part of routine practice in Irish EIS.

Qualitative interviews were conducted with 12 healthcare workers from three Irish EIS sites between September 2023 and July 2024. Data were analysed using Framework Analysis, with an abductive approach that mapped initial insights to the Consolidated framework for implementation research (CFIR) to identify implementation barriers and facilitators. The cognitive screener used was the Letter Number sequencing task, selected for its predictive accuracy in previous research.

Several key barriers and facilitators to implementation were identified. These included a lack of standardised guidelines, insufficient resources, staff uncertainty and client-related challenges. Facilitators included the perceived clinical utility of the screener, the need for increased training and support, improved client engagement and system-level changes to facilitate adoption.

This study highlights a readiness among clinicians to integrate cognitive screening into routine care and identifies some of the key requirements for doing so, including formal guidance, staff training, and the use of tools that are practical and client-friendly. Responding to these needs can help bridge the gap between best-practice guidelines and routine clinical care, leading to more personalised and effective treatment for individuals with FEP.