Cornerstone: An Empirically-Supported Intervention for Transition-Age Youth with Mental Disorders

Background and Purpose: The needs of transition-age youth with serious mental challenges have not been satisfactorily addressed, and research has documented that transition-age youth are vulnerable to poor outcomes in adult life domains (Institute of Medicine, 2014). It is surprising then, that there are few interventions to address their unique needs. The purpose of this paper is to describe the Cornerstone Program, a theoretically guided intervention designed to improve the mental health and functioning of participants during the transition to adulthood, while also presenting the intervention development process, and describing the design and sample statistics for a newly funded NIMH randomized controlled trial.

Methods: The research team utilized multiple methods to refine Cornerstone. First, we mailed structured surveys to a set of scholars (N=6), along with preliminary manuals, to solicit feedback. Second, we developed an Advisory Board with multiple stakeholders (N=25, social workers, administrators, individuals with lived experience, young adults, and policy experts), which convened with the Principal Investigator on multiple occasions to discuss Cornerstone. Third, we met with clinic staff (N=26) on three occasions to discuss the program model. Qualitative data analysis occurred in a series of steps. First, all transcripts (surveys, field notes) were read multiple times by two analysts. Then, analysts individually coded data utilizing constant comparison, both within and between interviews. Then, analysts met numerous times to discuss emergent themes relevant to the refinement of the program. Discrepancies were resolved through consensus. Themes and illustrative quotes constitute the results. Further, descriptive statistics will be presented on the sample and baseline functioning of participants in a newly-funded NIMH randomized controlled trial, which will be described in detail.

Results: The presentation provides a blueprint for intervention development research with the following three steps: 1) establishment of strong theoretical basis, 2) design of the initial manual, and 3) systematically examining feedback from various stakeholders for refinement of the final manual. In our qualitative study of Cornerstone, participants reported the following areas for refinement: 1) further integration of caregivers, 2) focus on strategies to address substance use, 3) increase effort to both identify social supports and also support developing the relationships, and 4) development of Recovery Role Model position.  After presenting themes, presenters will describe the finalized model for Cornerstone which includes four components: 1) Boundary-Spanning Case Management; 2) Skills- and Literacy- groups; 3) Mentoring Program with Recovery Role Models; and, 4) In-Vivo Community-Based Practice. The mean age of the participants in the randomized trial is 17.4, and they are 75% female, and 68% youth of color. At baseline, 100% of the sample met criteria for depression, and the majority of the participants are living with mood and anxiety disorders.

Conclusions and Implications: There are few evidence-based practices designed for transition-age youth with serious mental health conditions.  Cornerstone is one program which is based on theory, and incorporates principles of evidence-based practices, such as Critical Time Intervention, Trauma-Focused Cognitive Behavioral Therapy, and Youth Mentoring to provide a “Touchstone” for young people as they make the often precarious transition to adulthood.