Cornerstone Program for Transition-Age Youth Study Protocol for a Randomized Controlled Trial
Condition: Depression; Stress Disorders, Post-traumatic; Bipolar Disorder
MeSH terms: Bipolar Disorder; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The purpose of this study is exploring a theoretically guided intervention, Cornerstone,
      which provides system 'boundary-spanning' services, including therapeutic services and
      mentorship, to transition-age youth with mental disorders. Cornerstone is designed to improve
      mental health service engagement and outcomes. The study uses a mixed methods approach to
      refine Cornerstone, and a hybrid design examining feasibility, acceptability, and preliminary
      impact with a randomized trial, alongside implementation.
    

Detailed description: 
      The goal of this RCT is to refine and examine the feasibility, acceptability and preliminary
      impact of a theoretically guided intervention that provides system 'boundary-spanning'
      services to improve mental health service use and outcomes for low-income, transition-age
      youth with mental disorders (TAYMD). Through the refinement and testing of this intervention,
      called Cornerstone, we aim to address mental health challenges as well as the practical
      obstacles, such as lack of education, housing, and employment, that impede successful
      transition to adulthood. Cornerstone addresses these challenges by providing a service
      delivery strategy that spans the transition from the child to the adult system.

      Cornerstone centers on addressing three pressing problems: (1) the discontinuation, or at
      best fragmentation, of mental health care for TAYMD, (2) the lack of evidence-based
      interventions for TAYMD, and (3) the reality that promising practices for TAYMD, many of
      which Cornerstone builds upon, have not been tested with a sample that moves from child to
      adult services. Cornerstone deals with these problems in innovative ways at a time of
      transformation in health care. First, Cornerstone provides a 'boundary spanning case manager'
      (BSCM) across the transition. That is, rather than extending the age of service provision in
      the child system, we prioritize collaboration with the adult system and practical assistance
      to assure that the transition to developmentally and clinically appropriate adult services
      and independent adulthood happen at age 18. Second, Cornerstone incorporates an innovative
      form of social support, namely a recovery role model mentor (RRM) who is a decade older than
      TAYMD. The RRM co-facilitates weekly groups and provides important information and mentoring
      (i.e., modeling, connection) for TAYMD. Third, the development of Cornerstone is aligned with
      policy and practice transformation, particularly Affordable Care Act and New York State
      Medicaid Redesign, prioritizing coordinated, evidence-informed care for TAYMD, expansion of
      the workforce, and an emphasis on achieving functional outcomes and wellness.

      The aims are 1) to develop and refine all manuals and protocols for Cornerstone, 2) to
      determine the feasibility, acceptability, and preliminary impact of 'Cornerstone' relative to
      treatment as usual (TAU) on mediating outcomes (e.g., stigma), service use, and improved
      mental health and functioning outcomes, and 3) to explore implementation of Cornerstone
      through individual and group interviews with key stakeholder partners on aspects of the
      transforming local, state and national service context (e.g., staffing, payment). As a
      multidisciplinary team of professionals on the local, state, and national level we are
      committed to bridging the science to service gap for youth transitioning to adulthood with
      mental health challenges. Using qualitative methods and an RCT, this study is the first to
      examine a true transition intervention. We believe mental health services research that
      focuses on the transition to adulthood with innovative service delivery strategies that span
      developmental silos will decrease the number of TAYMD with unmet mental health needs.
    

Intervention name(s): Treatment As Usual; Cornerstone
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants in the TAU arm will be assigned to standard care at our partnering mental health agency. These clients are free to attend one-on-one counseling or any other services available at the clinic or elsewhere to address mental health challenges.; Participants in the experimental arm will be assigned a Transition Facilitator, a clinician with whom the client will meet one-on-one, and will be asked to attend once-a-week groups with other transition age youth. The groups will focus on issues relevant to successful transition to independent adulthood including stress and anger management and healthy relationships.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Multimodal psychosocial intervention
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Transition age youth; Mental health; Mental health services; Engagement