Cornerstone Program for Transition-Age Youth Study Protocol for a Randomized Controlled Trial

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.

Inclusion Criteria:

1. Be between ages 17 and 18 at time of enrollment in the study,

2. Diagnosed with a mental disorder, including those who are diagnosed with any other
co-morbid disorders,

Exclusion Criteria:

1. Does not speak English

2. Documented IQ lower than 70