Effectiveness of a virtual patient simulation training on improving provider engagement in suicide safer care.

BACKGROUND: Health care providers have a critical opportunity to mitigate the public health problem of suicide. Virtual patient simulations (VPS) allow providers to learn and practice evidence-based suicide prevention practices in a realistic and risk-free environment. The purpose of this study was to test whether receiving VPS training increases the likelihood that providers will engage in effective suicide safer care practices. METHODS: Behavioral health and non-behavioral health providers (N = 19) at a Federally Qualified Health Center who work with patients at risk for suicide received the VPS training on risk assessment, safety planning, and motivation to engage in treatment. Providers' electronic health records were compared 6 months pre- and post-VPS training on their engagement in suicide safer care practices of screening, assessment, safety planning, and adding suicide ideation to the problem list. RESULTS: Most behavioral health providers were already engaging in evidence-based suicide prevention care prior to the VPS training. Findings demonstrated the VPS training may impact the likelihood that non-behavioral health providers engage in suicide safer care practices. CONCLUSION: VPS training in evidence-based suicide prevention practices can optimize and elevate all health care providers' skills in suicide care regardless of role and responsibility, demonstrating the potential to directly impact patient outcomes.

Feasibility, Acceptability and Preliminary Implementation of the Cornerstone Program for Transition-Age Youth with Mental Health Conditions: A Mixed Methods Study.

Transition-age youth with mental health conditions from low socio-economic backgrounds often drop out of mental health services and, as such, do not receive therapeutic doses of treatment. Cornerstone is an innovative team-based, multi-component intervention designed to address the clinical needs of this understudied population through coordination and extensive provision of services in vivo (in the community). The present study used a convergent parallel mixed-methods design. Researchers collected quantitative and qualitative data during a small developmental trial, analyzing the two data types independently and then exploring them side-by-side to evaluate feasibility, acceptability, and preliminary implementation. Semi-structured interviews and quantitative surveys were conducted with transition-age youth, clinic staff, and policy makers. Qualitative interview guides were developed using the Consolidated Framework for Implementation Research to build understanding on implementation determinants alongside feasibility and acceptability. A two-group preliminary randomized trial was conducted to assess feasibility outcomes, such as recruitment, randomization, measurement performance, and trends in pre- to post- outcomes. Using grounded theory coding techniques, transcripts were coded by multiple coders, and themes were identified on acceptability and implementation. The team recruited fifty-six transition-age youth. Randomization was used in the study and the intervention was provided without incident. Results suggest individual components with both the social worker and mentor were more acceptable to participants than group-based approaches. Thematic analyses revealed themes associated with the inner, outer, and policy contexts describing a range of critical implementation determinants. Findings suggest that Cornerstone is feasible, acceptable, and promising for transition-age youth. It represents an innovative multi-component intervention worth exploring for transition-age youth with mental health conditions in a larger efficacy trial.Trial registration: The trial was registered at ClinicalTrials.gov (NCT02696109) on 22 April 16, Protocol Record R34-MH102525-01A1, New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial.

Young adult trauma symptoms in the context of community violence exposure.

AIMS: The primary purpose of this study is to understand how community violence exposure is associated with both common and unique variance characterizing posttraumatic stress (PTS) symptoms among young adults living in a low-resourced setting. METHODS: Data were collected using a cross-sectional survey design. Participants were recruited from public housing developments in a city in the eastern United States. Participants completed a survey that included questions related to community violence, PTS symptoms, and optimism. Data were analyzed using structural equation modeling. RESULTS: We found a relationship between a generalized PTS response and each of the PTS symptom categories. Experiencing community violence was significantly related to generalized PTS response over and above other traumatic events. CONCLUSION: Young adults who experience community violence have a general distress response to those experiences, and yet, beyond that general response, there are ways in which each symptom is distinct from a generalized distress reaction.

Acceptability, feasibility and outcome of a screening programme for complicated grief in integrated primary and behavioural health care clinics.

BACKGROUND: Complicated grief, a syndrome of persistent grief diagnosed >6 months following the loss of someone close is expected to be included in the 11th revision of the International Classification of Diseases as a new diagnosis called prolonged grief disorder. Complicated grief is associated with impaired functioning and health comorbidity and does not respond to treatments for depression. Individuals may seek help in primary care where providers need to be familiar with the syndrome. OBJECTIVE: This study examines the acceptability, feasibility and outcome of a screening programme for complicated grief among diverse adults receiving behavioural health services in integrated primary care. METHODS: Behavioural health providers (n = 14) administered the Brief Grief Questionnaire and the Inventory of Complicated Grief during routine assessment and completed an acceptability survey. Descriptive statistics described rates of complicated grief symptoms and sample demographics, health and service use. RESULTS: Most providers (71%) reported the Brief Grief Questionnaire to be a moderate to very useful assessment instrument and the Inventory of Complicated Grief moderate to very useful for developing a treatment plan (57%). Of the 2425 patients screened, 1015 reported a loss over 6 months ago. Of these 1015, 28% (n = 282) screened positive on the Brief Grief Questionnaire and 22% (n = 228) endorsed symptoms of complicated grief (Inventory of Complicated Grief score ≥25), considered at high risk for needing clinical care. CONCLUSIONS: A screening programme for identifying complicated grief was acceptable to providers, feasible to implement and useful in identifying complicated grief in integrated primary care clinics.

A prognostic model for ovarian neoplasms established by an integrated analysis of 1580 transcriptomic profiles.

Even after debulking surgery combined with chemotherapy or new adjuvant chemotherapy paired with internal surgery, the average year of disease free survival in advanced ovarian cancer was approximately 1.7 years1. The development of a molecular predictor of early recurrence would allow for the identification of ovarian cancer (OC) patients with high risk of relapse. The Ovarian Cancer Disease Free Survival Predictor (ODFSP), a predictive model constructed from a special set of 1580 OC tumors in which gene expression was assessed using both microarray and sequencing platforms, was created by our team. To construct gene expression barcodes that were resistant to biases caused by disparate profiling platforms and batch effects, we employed a meta-analysis methodology that was based on the binary gene pair technique. We demonstrate that ODFSP is a reliable single-sample predictor of early recurrence (1 year or less) using the largest pool of OC transcriptome data sets available to date. The ODFSP model showed significantly high prognostic value for binary recurrence prediction unaffected by clinicopathologic factors, with a meta-estimate of the area under the receiver operating curve of 0.64 (P = 4.6E-05) and a D-index (robust hazard ratio) of 1.67 (P = 9.2E-06), respectively. GO analysis of ODFSP's 2040 gene pairs (collapsed to 886 distinct genes) revealed the involvement in small molecular catabolic process, sulfur compound metabolic process, organic acid catabolic process, sulfur compound biosynthetic process, glycosaminoglycan metabolic process and aminometabolic process. Kyoto encyclopedia of genes and genomes pathway analysis of ODFSP's signature genes identified prominent pathways that included cAMP signaling pathway and FoxO signaling pathway. By identifying individuals who might benefit from a more aggressive treatment plan or enrolment in a clinical trial but who will not benefit from standard surgery or chemotherapy, ODFSP could help with treatment decisions.

A qualitative study of provider feedback on the feasibility and acceptability of virtual patient simulations for suicide prevention training.

Background: Healthcare organizations are often committed to preventing suicide among their patients, but they can struggle to adequately train providers and implement strategies grounded in evidence-based suicide prevention practices. Virtual patient simulations (VPS) offer the opportunity for providers at healthcare organizations and educational institutions to learn suicide prevention strategies using a realistic and risk-free environment. The purpose of this study was to gather feedback from leaders in the healthcare field regarding the feasibility and acceptability of VPS for their organizations. Methods: Participants (N=9) included administrators, managers, and educators from a variety of health care settings. They were invited to independently test the VPS and participate in a subsequent focus group to provide feedback. Participants were asked about VPS acceptability, satisfaction, potential fit within the intended context, feasibility of delivery, motivation to use, and likelihood of adoption. Responses were audio recorded and transcribed for coding and thematic analysis. Results: Themes emerged regarding perceived benefits of the VPS, considerations related to cost, barriers to implementation, and suggestions for improvement. Participants reported VPS trainings were acceptable and feasible, filling an important gap in the field especially around suicide safety planning, particularly for newer clinicians and students in training. Participants felt that this type of virtual training was particularly feasible given the recent increase in need for online trainings. Suggested improvements included the need to normalize the trial-and-error nature of the VPS for trainees prior to the start of the training, and to consider shortening the duration of the simulation due to learners not being able to bill for time while training. Conclusions: VPS may help to fill an important training need in the field of suicide prevention. The training suite may be best suited for certain settings, such as educational institutions, and most useful for populations including students and new clinicians. VPS may be particularly feasible for organizations that already utilize remote options for work and training.

Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness.

OBJECTIVE: Serious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery. METHODS: The study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up. RESULTS: Participants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program. CONCLUSION: This study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.

Outcomes of a Metaintervention to Improve Treatment Engagement Among Young Adults With Serious Mental Illnesses: Application of a Pilot Randomized Explanatory Design.

PURPOSE: The objective of this study was to conduct a preliminary evaluation of a new young adult-centered metaintervention to improve treatment engagement among those with serious mental illness. METHODS: Young adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. RESULTS: The randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such as hope, self-efficacy, and emotional reactions to treatment. These results inform next steps in the development of this promising intervention. CONCLUSIONS: Just Do You illustrated feasibility, acceptability and preliminary impact. It represents an innovative metaintervention that has promise for improving treatment engagement in mental health services among young adults who have a history of poor engagement.

Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial.

BACKGROUND: Young adults have elevated rates of mental health disorders, yet they often do not receive consistent care. The challenge of continuing to engage young adults has been pervasive worldwide. Few engagement interventions have been designed for young adults with serious mental illness. Just Do You is a theoretically guided engagement intervention. It uses innovative modalities (i.e., technology, expressive arts activities, narrative expression, mentoring) to engage participants in conversations about services and how they work, while simultaneously orienting them to treatment. METHODS/DESIGN: This pilot and feasibility study utilizes a hybrid research design, examining feasibility, acceptability, and preliminary impact, alongside implementation. The study combines qualitative methods, a small pilot randomized trial, and a small cost-benefit analysis. Respondents are clinic staff and young adults who have made initial contact with the Personalized Recovery Oriented Services (PROS) program. Quantitative survey data are collected at baseline, 2 weeks (post-intervention), 1 month, and 3 months. The assessments focus on measuring feasibility, acceptability, engagement, and mental health outcomes. Medical record extraction will be used to triangulate self-report data. We will conduct single degree of freedom contrasts to examine whether Just Do You leads to improved outcomes relative to Treatment-As-Usual using robust regression for each outcome measure. We will examine whether changes in the proposed mediating variables occur across groups using a similar contrast strategy. In addition, we will use structural equation modeling to examine the contribution of mediators to ultimate outcomes. Finally, we will use constant comparison coding techniques for qualitative analyses. DISCUSSION: The aim of this study is to examine the feasibility of a young adult engagement meta-intervention through an intensive preliminary pilot trial, learning through collaboration with stakeholders. Just Do You has the potential to fill a gap in the service system for young adults with serious mental illnesses, improving the seemingly intractable problem of disengagement. The program uses culturally responsive strategies, is recovery-oriented, and builds upon the best evidence to date. Our efforts align with local and national health care reform efforts embedding people with lived experience. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov (Identifier: NCT03423212) on April 18, 2018, as Protocol Record R34 MH111861-01, New York University, as the Just Do You Program for Young Adults with Serious Mental Illness.

A mixed-methods investigation into the perspectives on mental health and professional treatment among former system youth with mood disorders.

Research has shown that how people think about their health (or illnesses) shapes their help-seeking behavior. In this mixed-methods study, we employed a simultaneous concurrent design to explore the perceptions of mental illness among an understudied population: marginalized young adults. Participants were 60 young adults (ages 18-25) who had experienced mood disorders and used multiple public systems of care during their childhoods. Semistructured interviews were conducted to understand participants' illness and treatment experiences during the transition to adulthood. A team of analysts used constant comparison to develop a codebook of the qualitative themes, and quantitative data were examined using SAS 9.3. Findings suggest that some theoretical categories identified in past illness-perceptions frameworks are salient to marginalized young adults (e.g., identity, management-or control-of symptoms), but both the developmental transition to adulthood and experiences with public systems of care add nuanced variations to illness and treatment perceptions. Our study demonstrates that young adults possess a set of beliefs and emotions about their mental health and help-seeking options that need to be better understood to improve engagement and quality of mental health care for this population. Implications for practice, research, and policy are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mental health service use decision-making among young adults at clinical high risk for developing psychosis.

AIM: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have the capability to recognize that they have a problem and initiate mental health services, yet there is a paucity of theoretically based research examining this decision-making process. This is critical to study because there are high rates of underutilization of mental health services among these young people. The following study explored the decision-making process among young adults at CHR in order to understand mental health services utilization at a CHR clinic. METHODS: Semi-structured face-to-face interviews were conducted with 30 young adults at CHR between the ages of 18 and 30, from an Eastern city in the United States. The study applied the unified theory of behaviour (UTB), a decision-making framework for health behaviour, to examine service use. Content analysis with multiple coders was used. RESULTS: The most salient constructs discussed when participants envisioned seeking services at the clinic included attitudes or beliefs about help-seeking, social image beliefs and emotional reactions towards seeking services. Differences in UTB responses emerged depending on whether participants were engaged in clinical services and research at the time of the interview or just taking part in research follow-ups. CONCLUSION: When designing future interventions to increase service utilization among young adults at CHR, programs can address health beliefs such as how services at the clinic can improve symptoms, stigma and difficult emotions such as fear and shame about seeking services, and particularly among young people who are more ambivalent about seeking clinical services.

A conceptual model of mental health service utilization among young adults at clinical high-risk for developing psychosis.

OBJECTIVE: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have difficulties seeking, accessing, and staying engaged with mental health services. The present study explored perspectives on engagement with mental health services among young adults at CHR. METHOD: In-depth interviews were conducted with 30 participants at CHR, ages 18-30, from an Eastern U.S. state. Grounded theory methodology was used to analyzed qualitative data. RESULTS: Six major categories emerged from the data reflecting participants' perspectives of engagement with services. Contextual factors such as social, community, and online networks mattered to young adults, and individual factors such as level of awareness, stigma, emotions, and environmental factors emerged as critical. These factors suggested a conceptual model of service utilization among young adults at clinical high risk for developing psychosis that builds upon and extends existing conceptual frameworks of service use among young adults. CONCLUSION AND IMPLICATIONS FOR PRACTICE: A conceptual model of service utilization among young adults at CHR emerged from that data that can inform interventions aimed at improving engagement in services and reduce the amount of time young adults at CHR remain untreated for emerging psychological problems. Furthermore, this study highlights the unique contribution of mental health service use messages received from online networks and a possible relationship between hierarchical stigma and service use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suicide risk assessment training using an online virtual patient simulation.

BACKGROUND: Improving the identification of and intervention with patients at risk for suicide requires innovative training techniques that safely and effectively teach or enhance practitioners' skills. Virtual patient simulations (VPS) can be particularly effective for this purpose because they allow for repetition in skill building as well as a safe space to practice difficult interactions with patients. The purpose of this study was to assess the feasibility and acceptability of a novel VPS that trains practitioners in suicide risk assessment, as well as to examine pre-post changes in suicide-related knowledge through a pilot of the VPS training. METHODS: Practitioners (n=20) were recruited from a Federally Qualified Health Center in the northeastern United States to test the feasibility and acceptability of a VPS suicide risk assessment training. A paired samples t-test was conducted to compare mean differences in practitioners' suicide risk assessment knowledge scores from pre- to post-training, on a scale of 0 to 10. RESULTS: The VPS was feasible to implement, with 18 of 20 participants using the VPS for an average of 21 to 95 minutes, and was acceptable to participants, with an average satisfaction rating of 5.82 out of 7. Participants' knowledge scores improved significantly by an average of 1.86 points from pre- to post-training. CONCLUSIONS: The VPS was feasible and acceptable to this sample of practitioners and significantly increased knowledge from pre- to post-training. As such, VPS holds promise as a technique to develop skills in suicide risk assessment.

Integrating Safety Plans for Suicidal Patients Into Patient Portals: Challenges and Opportunities.

Safety planning is an emerging evidence-based practice that is effective at decreasing suicidal behaviors. As electronic medical records and patient portals become more prevalent, patients and clinicians have recognized the value of using this technology in the safety planning process. This column describes the experience of one federally qualified health center, the Institute for Family Health, in integrating safety plans into the patient portal. The authors argue that incorporating safety plans into patient portals may unlock a new to way to expand safety planning efforts in health settings-a way that may ultimately save lives.

Race and gender differences in attitudes toward help seeking among marginalized young adults with mood disorders: A mixed-methods investigation.

OBJECTIVE: Race and gender differences in help seeking are well-established; however, reasons for these differences are less clear. This study examined race and gender differences in two potential contributors-perceptions of illness and attitudes toward treatment-in a sample of marginalized young adults. METHOD: Interviews were conducted with young adults (age 18-25) with prior involvement in public systems of care and mood disorder diagnoses (n = 60). A quantitative interview assessed illness perceptions and attitudes followed by a qualitative interview focused on perceptions of mental illness and treatment. Analyses examined quantitative differences across four race/gender subgroups-White women (n = 13), White men (n = 6), women of color (n = 27), and men of color (n = 14), then qualitative results were reviewed for a subset of cases (n = 30) to understand differences revealed in the quantitative analyses. RESULTS: Women of color had lower scores on illness understanding compared to other groups and men of color had lower scores on chronicity. Attitudes including propensity toward help seeking and stigma resistance were lowest in men of color, followed by women of color. Qualitative findings supported that men of color viewed their symptoms as less chronic and managed symptoms by changing their mindset rather than formal treatments. White participants talked more about their illnesses as chronic conditions and spoke more positively of treatment. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Race/gender differences were identified, particularly in relation to views of mental illness and stigma. Messaging that highlights independence and strength in relation to managing symptoms may be particularly important for young people of color. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Domains of human U4atac snRNA required for U12-dependent splicing in vivo.

U4atac snRNA forms a base-paired complex with U6atac snRNA. Both snRNAs are required for the splicing of the minor U12-dependent class of eukaryotic nuclear introns. We have developed a new genetic suppression assay to investigate the in vivo roles of several regions of U4atac snRNA in U12-dependent splicing. We show that both the stem I and stem II regions, which have been proposed to pair with U6atac snRNA, are required for in vivo splicing. Splicing activity also requires U4atac sequences in the 5' stem-loop element that bind a 15.5 kDa protein that also binds to a similar region of U4 snRNA. In contrast, mutations in the region immediately following the stem I interaction region, as well as a deletion of the distal portion of the 3' stem-loop element, were active for splicing. Complete deletion of the 3' stem-loop element abolished in vivo splicing function as did a mutation of the Sm protein binding site. These results show that the in vivo sequence requirements of U4atac snRNA are similar to those described previously for U4 snRNA using in vitro assays and provide experimental support for models of the U4atac/U6atac snRNA interaction.

An Engagement Intervention for Young Adults with Serious Mental Health Conditions.

Young adults with serious mental health conditions (SMHCs) often do not engage continuously with mental health services, and there are few engagement interventions designed for them. This qualitative study presents a blueprint for conceptualizing and developing an engagement intervention designed for young adults with SMHCs. The blueprint includes the following activities: (1) establishing a strong theoretical basis, (2) designing an initial manual based on previous research and practice, (3) systematically examining feedback on the manual from stakeholders, and (4) examining the feasibility, acceptability, and implementation demands of the intervention. Interviews, group discussions, and journaling were utilized to collect information from young adult participant-researchers, intervention facilitators (i.e., recovery role models and clinicians), and additional stakeholders (e.g., clinic staff and administrators) (N = 43). Analyses were performed with multiple coders using constant comparative methods. Results revealed critical information to improve the intervention, while also suggesting that the engagement intervention for young adults with SMHCs has promise.

Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial.

BACKGROUND: Transition-age youth have elevated rates of mental disorders, and they often do not receive services. This is a serious public health concern, as mental health conditions persist into adulthood. Continuing to engage this population has been a pervasive challenge for the mental health care system worldwide. Few mental health interventions have been developed for transition-age youth, and even fewer have been found to be effective over the transition to adulthood. Cornerstone, a theoretically guided intervention has shown promise for addressing the mental health and psychosocial needs of this population as they emerge into adulthood. Cornerstone provides case management, trauma-focused cognitive behavioral therapy, mentoring/peer support, community-based in vivo practice, and groups to address stigma, mistrust, and practical skill development to improve the transition to independence among transition-age youth with serious mental health conditions. METHODS/DESIGN: This study utilizes a hybrid research design and focuses on examining feasibility, acceptability and preliminary impact, along with factors that influence implementation, to maximize new knowledge. The study combines qualitative methods and a randomized controlled trial, using data to inform and refine protocols and manuals, while testing the preliminary impact of the intervention, compared to best available services (treatment as usual, TAU) at a partnering outpatient mental health clinic (n = 60). Contributors to the intervention development research (n = 20) are national experts on mental health services, clinic administrators and staff and young adults with direct experience. The intervention involves intensive staff training and 18 months of ongoing service provision, monitoring and supervision. Quantitative survey data will be collected at baseline, 3 months, 6 months, and 9 months measuring mental health and practical life outcomes via self-report measures. Medical records will be used to triangulate self-report data (i.e., primary diagnosis, treatment planning and attendance). Qualitative data focuses on the intervention development process and implementation research and will use constant comparison coding techniques. In this intention-to-treat analysis, we will conduct basic omnibus analyses to examine whether Cornerstone leads to improved outcomes relative to TAU utilizing t tests across treatment conditions for each outcome measure specified. We will likewise examine whether changes in the proposed mediating variables differ across groups. DISCUSSION: The aim of this study is to refine Cornerstone through an intensive preliminary trial, learning through collaboration with clinic staff, project team members, and leaders in New York State and nationwide on how to best serve transition-age youth with serious mental health conditions. Cornerstone has the potential to fill a large gap in the service system for transition-age youth with serious mental health conditions, and may enhance the menu of care options for those who have been recently diagnosed with a serious mental health condition, and yet, have a long life to live. The program is recovery-oriented, builds on the best evidence to date, and is in line with both local and national health care reform efforts. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov (Identifier: NCT02696109 ) on 22 April 16 as Protocol Record R34-MH102525-01A1MRM, as New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial.