? PROJECT 1 Consistent with the aims of the OPAL center, this project will explore adaptations of treatments for schizophrenia, with the goal of optimizing their effectiveness in real-world clinical settings and readiness for broad deployment. Schizophrenia is associated with cognitive deficits that negatively impact essential areas of daily functioning. NY State Office of Mental Health (OMH) is the first and largest state system of care to implement a statewide program of cognitive remediation (CR), an evidence-based practice for improving cognition and aiding functional recovery. Through Cognitive Remediation to Promote Recovery (CR2PR), CR is now offered in outpatient programs, with plans to expand to more services and further adapt implementation to improve treatment outcomes. This project will work directly with OMH clinics and clinicians, and draw on the resources of the Center's trans-disciplinary expertise to build upon and improve current CR delivery methods. This project will study the impact of two adaptations. One adaptation focuses on increasing the accessibility of the program, which participants report is limited by the requirement of twice weekly attendance. This project will therefore compare the feasibility and acceptability of delivering CR in either two clinic-based sessions (Clinic) or one clinic and one remote session (Hybrid) per week. Semi-structured qualitative interviews will be conducted with stakeholders to explore the impact of the adaptation. The second adaptation is intended to improve personalization of CR by systematically accounting for individual differences in neurocognitive needs. Drawing upon convergent evidence for tailoring CR based on need for early auditory processing (EAP) training, this project examines whether integrating a measure of EAP into the current baseline assessment facilitates personalization of the menu of restorative computer-based exercises used in CR. The team's expertise in CR implementation and dissemination, clinical trials, and integrative quantitative and qualitative methods altogether support the aims of this project. Feasibility parameters and qualitative/quantitative data analyses of facilitators and barriers to Hybrid CR delivery will together inform further treatment refinement and the design of a larger effectiveness trial of Clinic versus Hybrid CR. We will study how EAP assessment is employed by practitioners to personalize the CR treatment plan and examine if EAP improvement is associated with cognitive outcomes in public practice CR settings. Finally we will compare cognitive, functional, and service use outcomes in Hybrid versus Clinic CR and use exploratory methods to test whether subgroups of patients benefit more from Hybrid or Clinic delivery approaches. This project supports the mission of the Center, to rapidly translate laboratory evidence to clinical practice in a manner congruent with the realities of publically funded clinics. By improving CR utilization and treatment outcomes in large systems of care, this project has the potential to impact the lives of many people with schizophrenia.