Cornerstone: Boundary Spanning Case Management and Peer Support for Youth

基石：跨界案例管理和青少年同伴支持

• 批准号: 8772997
• 负责人: MICHELLE R. MUNSON
• 金额: $ 15.84万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772997
• 关键词: Achievement; Address; Adult; Age; Ambulatory Care Facilities; Anger; Caring; Case Management; Case Manager; Child; Clinic; Collaborations; Commit; Communities; Consensus; Coping Skills; Coupled; Data; Depressed mood; Development; Diagnostic; Education; Educational process of instructing; Employment; Evidence based intervention; Foundations; Goals; Group Interviews; Health Insurance; Health Services Research; Health system; Healthcare; Housing; Hybrids; Individual; Intervention; Interview; Knowledge; Low income; Manuals; Mediating; Medicaid; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methods; Modeling; New York; Outcome; Policies; Positioning Attribute; Process; Protocols documentation; Provider; Qualitative Methods; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Relative (related person); Research; Sampling; Science; Scientist; Secure; Services; Social support; System; Testing; Time; Training; Work; Youth; base; care systems; clinical practice; cost; design; experience; functional outcomes; improved; in vivo; innovation; meetings; member; multidisciplinary; payment; peer; primary outcome; public health relevance; response; role model; skills; social stigma; treatment as usual; young adult

DESCRIPTION (provided by applicant): In response to PA-12-279, the goal of this R34 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.

描述（由申请人提供）：为响应PA-12-279，本R34的目标是完善和检查理论指导干预的可行性、可接受性和初步影响，该干预提供系统“跨越边界”服务，以改善低收入、过渡年龄青年精神障碍（TAYMD）的精神卫生服务使用和结局。通过改进和测试这种干预措施，称为基石，我们的目标是解决心理健康挑战以及实际障碍，如缺乏教育，住房和就业，阻碍成功过渡到成年。Cornerstone通过提供一种服务提供战略来应对这些挑战，该战略涵盖了从儿童到 成人系统 基石集中在解决三个紧迫的问题：（1）中断，或充其量碎片，心理健康护理的TAYMD，（2）缺乏证据为基础的干预措施TAYMD，和（3）现实，有希望的做法，TAYMD，其中许多基石的基础上，没有经过测试的样本，从儿童到成人服务。基石在医疗保健转型时期以创新的方式处理这些问题。首先，Cornerstone提供了一个跨转换的“边界跨越案例管理器”（BSCM）。也就是说，我们不是延长儿童系统提供服务的年龄，而是优先考虑与成人系统的合作和实际援助，以确保在18岁时过渡到发育和临床适当的成人服务和独立的成年期。其次，基石采用了一种创新形式的社会支持，即恢复榜样导师（RRM）谁是十年以上TAYMD。RRM共同促进每周小组，并提供重要信息和指导（即，建模、连接）用于TAYMD。第三，基石的发展与政策和实践转型相一致，特别是平价医疗法案和纽约州医疗补助重新设计，优先考虑TAYMD的协调，循证护理，扩大劳动力，并强调实现功能成果和健康。 其目的是：1）开发和完善基石的所有手册和方案，2）确定“基石”相对于常规治疗（TAU）对调解结果的可行性、可接受性和初步影响（例如，污名），服务使用，以及改善心理健康和功能成果，以及3）通过与关键利益相关者合作伙伴的个人和团体访谈，探讨基石的实施情况，内容涉及改变地方，州和国家服务环境的各个方面（例如，人员配备、薪酬）。作为地方，州和国家层面的多学科专业团队，我们致力于弥合科学与服务的差距，为青少年过渡到成年期的心理健康挑战。使用定性方法和随机对照试验，这项研究是第一次检查一个真正的过渡干预。我们相信，专注于向成年过渡的心理健康服务研究，采用跨越发展孤岛的创新服务提供策略，将减少心理健康需求未得到满足的TAYMD人数。