Cornerstone: Boundary Spanning Case Management and Peer Support for Youth

描述(由申请人提供)：针对PA-12-279，本R34的目标是完善和检查理论指导的干预措施的可行性、可接受性和初步影响，该干预措施提供系统的跨越边界的服务，以改善低收入、过渡期患有精神障碍的青年(TAYMD)的精神健康服务使用和结果。通过改进和测试这一被称为基石的干预措施，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，这些障碍阻碍了成功过渡到成年人。基石通过提供从儿童到儿童的过渡的服务交付战略来应对这些挑战 成人系统。基石专注于解决三个紧迫的问题：(1)TAYMD的精神卫生保健中断，或者充其量是支离破碎的；(2)TAYMD缺乏循证干预；(3)许多Cornerstone建立在TAYMD基础上的有希望的做法尚未用从儿童到成人服务的样本进行测试。在医疗保健转型之际，基石以创新的方式处理这些问题。首先，Cornerstone在整个过渡过程中提供了“跨边界案例经理”(BSCM)。也就是说，我们没有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，以确保向发育和临床上合适的成人服务和独立成年的过渡发生在18岁。第二，基石纳入了一种创新的社会支持形式，即比TAYMD年长10岁的康复榜样导师(RRM)。RRM共同促进每周小组，并为TAYMD提供重要的信息和指导(即，建模、连接)。第三，基石的发展与政策和实践的转变保持一致，特别是《平价医疗法案》和纽约州医疗补助的重新设计，优先考虑为TAYMD提供协调、循证的护理，扩大劳动力，并强调实现功能结果和健康。其目标是1)制定和完善基石的所有手册和协议；2)确定“基石”相对于照常治疗(TAU)在调解结果(例如，耻辱)、服务使用以及改善心理健康和功能结果方面的可行性、可接受性和初步影响；以及3)通过与关键利益攸关方合作伙伴就转型的地方、州和国家服务背景(例如，人员配备、支付)方面的个人和小组访谈，探索基石的实施情况。作为一个由地方、州和国家层面的专业人员组成的多学科团队，我们致力于为面临心理健康挑战的成年青年弥合科学与服务之间的差距。使用定性方法和随机对照试验，这项研究是第一次检验真正的过渡干预。我们相信，通过跨越发展竖井的创新服务提供战略，专注于向成年期过渡的精神健康服务研究将减少有未得到满足的精神健康需求的TAYMD的数量。

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.