Michelle R. Munson, Ph.D. - US grants

DESCRIPTION (provided by applicant): The proposed F31 is a first step toward a research agenda investigating mentor relationships for youth with mental disorders. Focused investigation surrounding the initial onset of mental disorders, coupled with the influence of support relationships (e.g., mentoring), constitutes a psychosocial agenda to compliment recent pharmacological advancements for youth developing mental disorders. The research proposal focuses on older foster care youth, many who have mental disorders, and the influence of their natural mentors. Over the past decade, mentoring "at risk" youth has been found to be associated with positive outcomes. Yet, mentoring scholars have made minimal efforts to investigate this resource for transitioning foster care youth, a population with particular need for support. In addition, mentoring studies have only recently begun examining what qualities of the mentoring relationship promote such outcomes. This self-report survey of an estimated 250 youth (see page 15 for projected sample) will examine structural factors (e.g., duration) and the core qualities (e.g., engagement) of mentoring relationships utilizing an innovative measure. This cross-sectional study is part of a currently funded R01, entitled Mental Health and Service Use of Older Adolescents as they Leave Foster Care (R01 MH 61404), J. Curtis McMillen, P.I. The broad aims of the proposal are: 1) To describe the non-kin natural mentor relationships youth from the foster care system perceive as supportive and 2) To examine what about these relationships promotes positive outcomes.

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.

Project Summary In response to RFA-MH-16-410, this R34 addresses key NIMH priorities, 1) focusing on health disparities, and 2) development and preliminary testing of an innovative services intervention. We propose to refine and test the efficacy of a brief meta-intervention for young adults when they begin treatment at adult mental health clinics (hence, treatment and meta-intervention run concurrently). The meta-intervention is designed to reduce treatment dropout, a documented problem of significant public health concern, by helping young adults put treatment into perspective, better understand the rationale and goals of care, and address barriers to continued treatment as they build attendance routines and relationships with providers. To date, research has focused on `transition interventions,' namely programs within children's systems that serve transitioning youth into young adulthood, some of which have extended services into the early twenties. These programs create temporary additional support for youth while they are still in the children's systems. Our research suggests a complementary strategy that outreaches to youth who have formed tentative and initial engagement in services in the adult system, but who are at high risk of disengaging due to the failure of services to take into account the unique developmental needs and orientations of young adults. Our team developed a mid-level theory to understand the underlying mechanisms of disengagement. The theory integrates theories of service use with theories of decision-making, and suggests a set of factors (individual and contextual) impact disengagement among young adults with serious mental illness. Our intervention uses novel communication strategies to maintain the attention of young adults and impact these factors and thus, overall engagement. We use narrative communication (e.g., strategic storytelling as a means of conveying health information) to keep young adults connected to care and, in turn, improve functioning. We use a recovery role model who is a person who has had similar difficulties that young adults have as they first engage the adult mental health system. S/he leads activities and is a key resource. Although the recovery role model is related to approaches of peer support, it is distinct from and appeals to different mechanisms. One hundred ninety five young adults (3 groups, 65 per group) will be randomly assigned to either the intervention group, an active control group (curriculum on safe relationships), or the treatment as usual control group when they first enroll in services. Assessments are taken at baseline, 2-week posttest, 4-week follow-up and at a three month follow-up. The study aims are (1) to develop and preliminarily test the efficacy of a novel, 2-session engagement meta-intervention aimed at engagement and functioning outcomes for marginalized young adults with serious mental illness, and (2) to preliminarily identify the underlying mechanisms of change for disengagement in mental health care, i.e., mediators and moderators of intervention effectiveness. We will advance theory as well as strengthen the proposed intervention.

Project Summary In response to RFA-MH-16-410, this R34 addresses key NIMH priorities, 1) focusing on health disparities, and 2) development and preliminary testing of an innovative services intervention. We propose to refine and test the efficacy of a brief meta-intervention for young adults when they begin treatment at adult mental health clinics (hence, treatment and meta-intervention run concurrently). The meta-intervention is designed to reduce treatment dropout, a documented problem of significant public health concern, by helping young adults put treatment into perspective, better understand the rationale and goals of care, and address barriers to continued treatment as they build attendance routines and relationships with providers. To date, research has focused on `transition interventions,' namely programs within children's systems that serve transitioning youth into young adulthood, some of which have extended services into the early twenties. These programs create temporary additional support for youth while they are still in the children's systems. Our research suggests a complementary strategy that outreaches to youth who have formed tentative and initial engagement in services in the adult system, but who are at high risk of disengaging due to the failure of services to take into account the unique developmental needs and orientations of young adults. Our team developed a mid-level theory to understand the underlying mechanisms of disengagement. The theory integrates theories of service use with theories of decision-making, and suggests a set of factors (individual and contextual) impact disengagement among young adults with serious mental illness. Our intervention uses novel communication strategies to maintain the attention of young adults and impact these factors and thus, overall engagement. We use narrative communication (e.g., strategic storytelling as a means of conveying health information) to keep young adults connected to care and, in turn, improve functioning. We use a recovery role model who is a person who has had similar difficulties that young adults have as they first engage the adult mental health system. S/he leads activities and is a key resource. Although the recovery role model is related to approaches of peer support, it is distinct from and appeals to different mechanisms. One hundred ninety five young adults (3 groups, 65 per group) will be randomly assigned to either the intervention group, an active control group (curriculum on safe relationships), or the treatment as usual control group when they first enroll in services. Assessments are taken at baseline, 2-week posttest, 4-week follow-up and at a three month follow-up. The study aims are (1) to develop and preliminarily test the efficacy of a novel, 2-session engagement meta-intervention aimed at engagement and functioning outcomes for marginalized young adults with serious mental illness, and (2) to preliminarily identify the underlying mechanisms of change for disengagement in mental health care, i.e., mediators and moderators of intervention effectiveness. We will advance theory as well as strengthen the proposed intervention.