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Manuscript title: Successful Implementation of Integrative Cognitive Remediation for Early Psychosis -A Community Case Study Manuscript ID: 624091 Authors: Olina G Vidarsdottir, David L Roberts, Elizabeth W Twamley, Berglind Gudmundsdottir, Engilbert Sigurdsson, Brynja B Magnusdottir Journal: Frontiers in Psychiatry, section Schizophrenia Article type: Case Report Submitted on: 30 Oct 2020 Edited by: Frances Louise Dark

Research Topic: Design and Implementation of Rehabilitation Interventions for People with Complex Psychosis

Independent Review Report, Reviewer: Clément DONDÉ

EVALUATION Please summarize the main findings of the study. This is an interesting report that describes the implementation of an integrative cognitive remediation program in coordinated specialty care (CSC) for early psychosis in Iceland and investigate whether the intervention is sustainable in a CSC setting. Please highlight the limitations and strengths - Strengths: original and innovative study, importance of CR at the very onset of psychosis, well-written and well-conducted, comprehensive, very interesting and relevant advices on how to implement ICR.

• Limits: lack of information regarding the EIP service and patients involved in the ICR program. Checklist Is the English language of sufficient quality? Yes Is the quality of the figures and/or tables satisfactory? Yes Is the case study presented sufficiently unique? Yes Is the case study presented in an appropriate context with satisfactory reference to the relevant literature? Yes Are ethical guidelines adhered to? Explicitly considering both: animal and human subjects; national and institutional standards. Yes CARE guidelines checklist Further information on the CARE guidelines can be found here: https://www.care-statement.org/checklist. For negative replied, if any required element is missing from the manuscript, please provide further details in the comment box of Q5. Is the following information included and presented with clarity: a) de-identified demographic and other patient information; b) main concerns and symptoms of the patient; c) medical, family, and psychosocial history including genetic information; d) relevant past interventions and their outcomes? Yes Is the case presented in enough detail and does it mention all relevant physical examination (PE) and other clinical findings? No Is there a figure or table showcasing a timeline with relevant data from the episode of care? Yes Is the diagnostic assessment section adequately discussed according to the CARE guidelines checklist? Explicitly: diagnostic methods; diagnostic challenges; diagnostic reasoning including a differential diagnosis and prognostic characteristics when applicable No Is the therapeutic intervention properly described and justified, in line with the CARE guidelines? Explicitly: types of intervention; administration of intervention; changes in the interventions with explanations Yes Are the Follow-up and Outcomes sections discussed in detail and according to CARE guidelines? Explicitly: clinician- and patient- assessed outcomes, when appropriate; important follow-up diagnostic and other test results; intervention adherence and tolerability; adverse and unanticipated events Yes Does the discussion include all relevant details and address all possible concerns regarding the validity of the findings? Explicitly: strengths and limitations of the approach used; case and discussion of the relevant medical literature Yes Is the patient perspective provided and discussed? No Please provide your detailed review report to the editor and authors (including any comments on the Q3,4 Check Lists

• Page 2 line 50-52 : since other types of EIP setups have been described, author should clarify the demographic local context that justifies EIP as CSC in Iceland. For instance, an "hub and spoke" setup could be also interesting and recommended for large territories with rural areas (which seems to be the case in Iceland).

• Page 3 §2.1. : authors should add more information about the EIP : team name, number of staff members, case management or not, case-load, territory, clinical criteria for inclusion, type of clinical assessment, website if exists... Since local context is critical for EIP services development, these information might be helpful for reproducibility purposes.

• Page 3 §2.2. : author should justify why not integrating metacognitive training (MCT), and/or if integration of a future MCT module is planned for the ICR.

• Page 4 §2.3.3 : it would be interesting to described the neuropsychological testing (with scales/test batteries) that is offered before ICR and which criteria are necessary for ICR.

• Page 4. line 147 : more information have to be provided here (what measures and scores).

• Page 7. line 230 : the process is quite long but unfortunately this is how it is when we want to change things in medicine... some ideas and discussions on how to shorten this process and accelerate the implementation of EIP programs would be well-warranted. If authors want to discuss they can contact me and my EIP service in France (Grenoble, capital of the Alpes, at contact_calipso@ch-alpes-isere.fr). QUALITY ASSESSMENT: Originality 5 Rigor 3 Significance of the research results 4 Interest to a general audience 3 Quality of the writing 3 Overall quality of the study 3 REVISION LEVEL: What is the level of revision required based on your comments Moderate revisions