The Engagement Challenge: Feasibility and Acceptability of Cognitive Remediation for Teenagers in the Care of Youth Protection Services

Abstract

History of childhood maltreatment is recognized as an important risk factor for the development of mental health and cognitive difficulties. Cognitive difficulties are associated with impairments in everyday functioning in different domains such as school or work. To date, no study has evaluated the feasibility and acceptability of cognitive remediation therapy (CRT) with teenagers with a history of childhood maltreatment. The objective was to assess the acceptability and feasibility of the CIRCuiTS program for teenagers in youth protection services and to explore the preliminary effect on clinical and neuropsychological outcomes. Ten participants were first assessed with clinical and neuropsychological measures. They then received a mean of 16 CRT sessions with the CIRCuiTS program adapted for teenagers. The same measures as baseline were repeated directly after the end of treatment, as well as 3-months and 1-year post-treatment. Descriptive statistics were used to assess feasibility and acceptability, while the preliminary effect of CIRCuiTS was assessed with Reliable Change Indices (RCIs). CIRCuiTS was considered as acceptable by both participants and therapists for the attractiveness of the program, its easiness of use and understanding and its cultural adaptability. However, the feasibility was limited with only 50% of participants having had completed CIRCuiTS. This was mostly explained by contextual factors. RCIs revealed significant improvements in several neuropsychological domains, as well as a decline in other domains. This pilot study highlights challenges that must be addressed to promote engagement to CRT for teenagers in the care of youth protection services.