Translating Cognitive Remediation Therapy into Mental Health Practice: Implementing Computerised Interactive Remediation of Cognition and Thinking Skills (CIRCuiTS) for adults with psychosis in Australian public mental health services

This registration covers a multi-phase implementation study of Computerised Interactive Remediation of Cognition and Thinking Skills (CIRCuiTS) across four Australian public mental health services. The total duration of the study is approximately 4.5 years, comprising three sequential phases. Phase 1 (12 months) involves implementation planning workshops with clinicians, managers, peer workers, administrators, referrers, allied health staff, IT staff, and other stakeholders involved in implementing or supporting CIRCuiTS. One five-hour co-design workshop will be conducted at each site to develop local implementation plans and identify staffing, training, supervision, referral, resource, organisational support, and barriers and enablers to implementation. At the end of the workshops, participants will be asked to complete organisational readiness for implementing change (ORIC) survey. Participants will also prepare a site-specific implementation plan. Therapist training will be initiated during the latter part of Phase 1 and will continue into Phase 2 to accommodate workforce turnover and ensure ongoing service capacity. Therapists delivering CIRCuiTS will receive online training provided by King’s College London (KCL), consisting of 11 modules (approximately 11–22 hours in total). Additional therapists who join during Phase 2 will also complete this training prior to delivering the intervention. Phase 2 (30 months) will commence within 4–8 weeks following completion of Phase 1, allowing time for initial therapist training to be completed and for sites to finalise local implementation procedures. Ongoing training will continue throughout Phase 2 as needed to accommodate workforce turnover. Initiation of Phase 2 may be staggered across sites depending on readiness. Phase 2 involves implementation of CIRCuiTS for adults with psychosis. Participants who choose the intervention will receive 20 to 40 CIRCuiTS sessions delivered over approximately 12 to 24 weeks, usually 2 to 3 sessions per week, with each session lasting up to one hour. CIRCuiTS comprises several core components: Therapist facilitation: Therapists guide participants throughout sessions, supporting engagement, tailoring task difficulty, providing feedback, and helping participants reflect on cognitive strategies and performance. Cognitive exercises: Participants complete computer-based tasks targeting cognitive domains such as attention, memory, and executive functioning, with adaptive difficulty based on performance. Problem-solving strategies: Therapists support participants to develop and apply strategies (e.g., chunking, rehearsal, planning, error monitoring) to improve task performance and cognitive functioning. Transfer to real-world functioning: A key focus is on linking cognitive skills to everyday activities. Therapists work collaboratively with participants to set personal goals and practise applying strategies to real-life situations (e.g., work, study, social functioning). The number of sessions (20–40) is individualised and determined collaboratively by the therapist and participant based on clinical need, participant goals, progress, engagement, and service context. Therapists use clinical judgment and participant preference to adjust the duration and intensity of the intervention within this range, consistent with standard CIRCuiTS practice. Sessions will be delivered by trained therapists face-to-face, via telehealth, or using a hybrid model depending on site resources. CIRCuiTS will be delivered primarily on a one-to-one basis between therapist and participant. However, in some sites, the CIRCuiTS may also be delivered in small groups (typically 2–6 participants), where participants engage in individualised computer-based tasks with therapist facilitation in a shared setting. Group delivery will maintain the same therapeutic principles, including individual goal setting and strategy development, while allowing peer interaction and efficient use of clinical resources. Phase 3 (12 months) will commence following the completion of the 26-weeks post-intervention follow-up period for the final participant in Phase 2. This phase will involve data linkage for Phase 2 participants to examine maintenance outcomes, hospital admissions, and health service use over time. It will also include health outcomes, expressed in terms of quality-adjusted life years (QALYs) derived from EQ-5D-3L utility scores. Phase 3 will contribute to the development of guidelines for implementation and evaluation of Computerised Interactive Remediation of Cognition and Thinking Skills (CIRCuiTS) in Australian public mental health services.