Feasibility, Acceptability, and Preliminary Impact of the - - PowerPoint PPT Presentation

Feasibility, Acceptability, and Preliminary Impact of the Cornerstone Mentoring Program

Andrea Cole, PhD, MSW & Michelle Munson, PhD, MSW New York University Silver School of Social Work Shelly Ben-David, PhD, MSW University of British Columbia School of Social Work Beth Sapiro, ABD, MSW Rutgers University School of Social Work James Railey, ABD, MSW & Victoria Stanhope, PhD, MSW New York University Silver School of Social Work

Funding Supports

R34-MH102525-01A1 (PI: Michelle Munson PhD, Co-I: Victoria Stanhope, Mary McKay, Steven Marcus, James Jaccard)

Outline

• 1. Introduce the Cornerstone Program, which

includes youth mentoring

• 2. Results related to acceptability, feasibility, and

practicality of the mentoring component in a mental health outpatient setting

• 3. Preliminary results on the impact of Cornerstone

intervention for transition age youth (TAY)

Background: Transition Age Youth (16 – 21)

• High lifetime prevalence rates of mental disorders among

TAY (Kessler et al., 2009)

• Even higher prevalence among system youth and former

system youth (McMillen et al., 2005)

• Utilization of behavioral health care is lower among young

adults relative to children and older adults (Institute of Medicine, 2014)

Background: Mentoring

• Moderate effectiveness for improving academic and mental

health outcomes for TAY with mental health conditions (Munson & Railey, 2017).

• Few mentoring programs exist in mental health settings
• None recruit mentors who have lived experience with

mental illness and recovery.

Cornerstone Program

Cornerstone Case Management/ Counseling Mentoring Group Work In-Vivo

What is Cornerstone Mentoring Program?

Mentor

No Lived Experience

Older, wise, & trusted guide

Mentor Training, 1:1 Match, Weekly Activities, 1-year, Close Monitoring Community: Non-clinical service Mentorship, Role Modeling, Emotional Support, Fun and Companionship

Peer

Lived Experience

Same age, status or ability Training Varies, No 1:1 Match, Variation in Dose & Duration Clinic: “Form of mental health care” “Perhaps Mentorship”, Emotional Support, Hope, Education, Advocacy

Peer Support Youth Mentoring

DuBois & Karcher, 2013 Davidson et al., 2006

Recovery Role Model Mentors

Methods

Data Collection

• Pre-intervention interviews on the manual and protocols
• In-person individual interviews
• In-person group meetings
• Survey responses from national leaders in the field
• Post-intervention interviews on implementation

Participants

• 67 pre-intervention multidisciplinary expert interviews
• 23 case summaries by mentors
• 10 post-intervention stakeholder interviews (TFs, RRMs, clinical

administrators, state officials, research administrators)

Methods

Measures Developed an interview protocol on common implementation strategy domains (Powell et al., 2012) Analysis Strategy

• Thematic analysis utilizing constant comparison
• Multiple coders analyzed the data until saturation was met

“She responded extremely well to mentoring. She told me that I was the first person that she trusted ... I had a very strong connection and I really care for her. I found her resiliency inspiring.” “That’s one thing I did with the youth was tell them I’m in therapy, it’s okay, it’s really great. They really appreciated it.” “I think that the mentors are able to connect with the clients

• n a different level. They can share their personal experiences,

and just listening to my clients ... They felt like there was someone that they could relate to, some of their experiences were normalized.” Results: Acceptability of Mentoring

“You know specifically for me, I went out to one of the youths homes when she had disappeared for quite a while and the fact that I went and found her when she went off the grid seemed very powerful” “So I think the best thing about Cornerstone is that you are reaching children – by having the ability to go outside and do extra services and home visits … God forbid, have to go to the hospital or meet with caseworkers or school workers. I think the client feels the difference. I think they really feel that you care about that them.”

Results: Acceptability of In Vivo Mentoring

Results: Feasibility of Mentoring

Role requirements

1) use of mental health services as needed, 2) Identifies as living in recovery, 3) functioning well in terms of life domains (housing, employment) 4)

• btained a high school diploma or GED.

Training

• Relational & engagement skills
• Who trains: “I think it should be done by former mentors who have had therapy.”
• Boundaries (contact with mentors when clinic is closed?)
• Management of crises in the community

Results: Practicality

Reimbursement for peer services Use of technology for engagement

“I think one major think that worked well was having a cell phone to communicate with youth.” “Like texting was certainly a way to in which to access the youth”

Results: Adaptations Integration of mentors within the clinic and team

“I think to highlight the importance of the mentor’s role … where both the caregivers and child could meet the entire team they’ll be working with as they…represent everything as an intricate unit.”

Meetings between Mentor and Transition Facilitators

“Maybe there should be one on one meetings on a normal basis with the therapist and the mentor discussing how we can work together to help this person.”

Supervision

More consistent and paired

Results: Outcomes for TAY (N = 23)

Preliminary 3-Month Outcomes

Age: M = 17.83 Gender: Male = 22% (n = 5) Female = 78% (n = 18) Race/Ethnicity: Caucasian/White: 34% (n = 8) African American/Black: 22% (n = 5) Latino/Hispanic: 17% (n = 4) Asian: 13% (n = 3) Bi/Multiracial: 13% (n = 3)

Results: Outcomes for TAY (N = 23)

Preliminary 3-Month Outcomes

Mood: 48% Anxiety: 43% Schizophrenia spectrum: 9% Medication: 52.2% Psychosis: 43% (Have you ever experienced psychosis?) Maltreatment: Physical Abuse: 21.7% Physical Neglect: 26.1% Emotional Abuse: 56.5% Sexual Abuse: 48%

CES-D (Radloff, 1977)

20-items (Range 0-60, 0 = Rarely or none of the time, 5 = Most or all of the time) Sample Item: I felt sad.

Colorado Symptom Index (Shern et al., 1994)

10-items (Range 10-60, 1 = Every Day, 5 = Not at all), Higher Score the fewer the symptoms) Sample Item: In the past month, how often have you heard voices, or heard or seen things that other people didn’t think were there?

Recovery Assessment Scale-Short Form (Corrigan et al., 2004)

20-items (Range 20-100, 1 = Strongly Disagree, 5 = Strongly Agree) Sample Item: I’m hopeful about my future.

Internalized Stigma

11-items (Range 0-44, 0 = Strongly Disagree, 4 = Strongly Agree) Sample item: Teenagers my age who go to a mental health professional for their mood and emotional difficulties are crazy

Outcome Measures

20 22 24 26 28 30

Baseline 3-Months

Depression Time

t=2.15 (df=22), p=.04

25 27 29 31 33 35

Baseline 3-Months

Symptoms Time

t=2.43 (df=22), p=.02

70 72 74 76 78 80

Baseline 3-Months

Recovery Time

t=1.85 (df=22), p=.07

10 11 12 13 14 15

Baseline 3-Months

Stigma Time

t=1.93 (df=22), p=.07

Implications for Cornerstone

• Mentoring in mental health outpatient programs is

acceptable and feasible.

• There’s ways to improve the structure, supervision, training.
• Preliminary outcome data is trending in the direction one

would want so there’s reason to continue studying the model.

Implications for D& I Research

• Data were collected as part of a Hybrid Type 2 trial,

allowing for concurrent analysis of implementation and intervention data

• Implementation data can inform future iterations
• f the intervention

Thank you!

Contact Information: Michelle Munson, PhD: michelle.munson@nyu.edu Andrea Cole, PhD: arc483@nyu.edu

References

Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin, 32(3), 443-450. Dubois, D.L. & Karcher, M.J. (2013). Handbook of Youth Mentoring. Thousand Oaks, CA: Sage Publications, Inc. Kessler, R. C., Birnbaum, H., Bromet, E., Hwang, I., Sampson, N., & Shahly, V. (2009). Age differences in major depression: results from the national comorbidity survey replication (NCS-R). Psychological Medicine, 40. McMillen, J.C., Zima, B.T., Scott, L.D., Auslander, W.F., & Munson, M.R. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44(1), 88-95. Munson, M.R. & Railey, J. (2016). Mentoring for Youth with Mental Health Conditions: A Systematic

• Review. National Mentoring Research Council.

Powell, B.J., McMillen, J.C., Proctor, E.K., Carpenter, C.R., Griffey, R.T., Bunger, A.C. et al. (2012). A compilation of strategies of implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123-157.