NIH-Funded Cornerstone Study Tests Innovative Intervention for Youth With Mental Disorders Coming Into Adulthood

Cornerstone Team
Front Row: John Carlson (NYU Silver Alum, Cornerstone Supervisor); Deborah Zicht (Clinic Director); Noderea John (Cornerstone Provider) Back Row: Michelle Munson (Project PI); Tiffany Rasmussen (NYU Silver Alum, Cornerstone Provider); James Railey (NYU Silver PhD Student, Cornerstone Provider)

A research team led by NYU Silver Associate Professor Michelle R. Munson is currently conducting a randomized control trial (RCT) at the center of a three-phase, NIH-funded study to refine and test the feasibility, acceptability, and preliminary impact of Cornerstone, an intervention for low-income transition-age youth with serious mental health conditions.

Dr. Munson explained that so-called Transition-Age Youth, who range in age from 17-25, often face mental health challenges and practical obstacles during the transition to adulthood. This difficult situation can be further complicated when these youth are expected to move from the child-serving mental health system to the system that serves adults. “Research has shown young adults frequently discontinue treatment, or at best get fragmented care,” Dr. Munson said. “This can derail the achievement of critical adult milestones, such as education goals, securing stable housing, obtaining employment, and managing healthy relationships.”

According to Dr. Munson, the Cornerstone intervention is unique in that it provides intensive care coordination that bridges the often siloed child and adult mental health systems, and it provides a unique type of service where providers work together with youth both within the clinic and within the community. The program also addresses barriers to service engagement, like mistrust of the system. “With Cornerstone,” she said, “as young people move from the child to adult system, they receive continuous support from both a social worker known as a Boundary Spanning Case Manager (BSCM) and a non-professional peer, known as a Recovery Role Model (RRM), who has had sustained success in managing their mental health challenges and serves as an older, wiser guide and mentor.”

In the Cornerstone model, BSCMs collaborate with both the child and adult system and provide transition-age youth with linkage, support, coordination, and weekly individual and group sessions. RRMs convey valuable recovery lessons and assist with challenging real world experiences, including exploring employment options, and managing disclosure in a society that often discriminates against individuals with mental health challenges. Once a week, BSCMs and RRMs come together to co-facilitate group sessions to help participants build interpersonal skills and reduce isolation.

The first phase of the Cornerstone study, which lasted 9 months, focused on refining the intervention and modifying the manuals and protocols. This was done in collaboration with an advisory team assembled for the study, which included young adults, peers, as well as research and clinic staff, and experts in behavioral health, policy and transforming payment structures.

The second phase is the RCT, which is now in progress at Seymour Askin Counseling Center, a mental health clinic run by The Jewish Board, one of New York City’s largest providers of health and human services. So far the study team, which Dr. Munson noted includes a number of Silver School PhD and MSW students, has enrolled 40 of a total of 60 transition-age youth with serious mental health conditions. Half of the youth enrolled receive the refined Cornerstone intervention and the other half receive treatment as usual, which consists of the clinics’ individual counseling and medication management. Data is collected from youth in both arms of the trial at the start and end of the intervention period, with two follow-ups periods in between. Dr. Munson said the RCT will determine how feasible, realistic and relevant Cornerstone is for transition-age youth and provide preliminary information on how the intervention compares to treatment as usual in reducing barriers to mental health service use and improving outcomes.

The final phase of the study will involve in-depth, structured interviews with 20 key clinic staff, and experts in behavioral health policy and transforming payment structures, including Cornerstone advisors, to uncover factors that could facilitate or impede implementation of the intervention in real world, urban mental health settings. Dr. Munson said this phase, which will begin in December 2016 and take about 6 months, is an essential step if Cornerstone is to be translated from research into practice on a larger scale.

Dr. Munson anticipates using the results from all three phases of the study as pilot data to guide refinement of the Cornerstone intervention for a future large-scale randomized control trial. “My colleagues and I believe that this innovative, system-spanning intervention will decrease the number of transition-age youth with unmet mental health needs and improve their long-term mental health, functioning, and well-being outcomes. We are building the foundation for further research with sufficient power to determine if this is in fact the case, provide evidence of Cornerstone’s active ingredients, and guide adoption and sustainability of the intervention in our highly stressed public mental health systems.”