Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada.

AIM: Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic. METHODS: Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined. RESULTS: A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic. CONCLUSIONS: Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review.

OBJECTIVE: Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. METHODS: A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. RESULTS: The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. CONCLUSIONS: These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.

Factors that influence decision-making among youth who vape and youth who don't vape.

Vaping rates among Canadian youth are significantly higher compared to adults. While it is acknowledged that various personal and socio-environmental factors influence the risk of school-aged youth for vaping uptake, we don't know which known behavior change factors are most influential, for whom, and how. The Unified Theory of Behavior (UTB) brings together theoretically-based behavior change factors that influence health risk decision making. We aimed to use this framework to study the factors that influence decision making around vaping among school-aged youth. Qualitative interviews were conducted with 25 youth aged 12 to 18 who were either vaped or didn't vape. We employed a collaborative and directed content analysis approach and the UTB constructs served as the coding framework for analysis. Gender differences were explored in the analysis. We found that multiple intersecting factors play a significant role in youth decision making to vape. Youth who vaped and those who did not vape reported similar mediating determinants that either reinforced or challenged their decision-making, such as easy access to vaping, constant exposure to vaping, and the temptation of flavors. Youth who didn't vape reported individual determinants that strengthened their intentions to not vape, including more negative behavioral beliefs (e.g., vaping is harmful) and normative beliefs (e.g., family disapproves), and strong self-efficacy (e.g. self-confidence). Youth who did vape, however, reported individual determinants that supported their intentions to vape, such as social identity, coolness, and peer endorsement. The findings revealed cohesion across multiple determinants, suggesting that consideration of multiple determinents when developing prevention messages would be beneficial for reaching youth.

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.

Factors that influence the decision to vape among Indigenous youth.

BACKGROUND: The use of e-cigarettes (vaping) among Indigenous youth is much higher than that of their non-Indigenous counterparts, which has raised the concerns of various Indigenous scholars and communities. To better understand the most salient constructs that influence Indigenous youth decision-making around vaping, we co-created a qualitative research study with a Syilx First Nation community that was guided by the Unified Theory of Behavior (UTB). METHODS: Through semi-structured interviews and a sharing circle, we gathered the perspectives and experiences of 16 Syilx youth in British Columbia, Canada. After an initial collaborative coding and training session, the interviews were transcribed and coded by Indigenous peer researchers using Nvivo. Through both directed and conventional qualitative content analysis methods, the final conceptual framework was collaboratively developed. RESULTS: Syilx youth reported that vaping decision-making is underpinned by colonialism, and the historical disproportionate impact of the tobacco industry. The youth spoke to several individual determinants that influence intentions to vape (e.g., vaping helps you cope) and to not vape (e.g., family and community connectedness), and determinants that translate intentions to vape to decision to vape (e.g., access to vaping), and to not vape (e.g., access to trusted adults and support from the band). The youth suggested that prevention efforts must be informed by an understanding of why Indigenous youth vape and what strengthens their resolve to not vape. CONCLUSIONS: Vaping decision-making among Indigenous youth is underpinned by their cultures, contexts, and histories. To effectively address vaping among Indigenous youth, continued engagement of Indigenous youth in planning, developing, implementing, and evaluating both prevention and policies efforts is a necessity.

Service use Decision-Making among Youth Accessing Integrated Youth Services: Applying the Unified Theory of Behavior.

OBJECTIVE: With the development of 75% of mental health disorders before age 25, it is alarming that service use among youth is so low. Little theoretically driven research has explored the decision-making process youth make when accessing services. This study utilized a decision-making framework, the Unified Theory of Behavior (UTB), to understand service use among youth attending Foundry, a network of integrated youth services centres designed to support the health and wellbeing of youth. METHODS: Forty-one participants were recruited from one Foundry centre in an urban community in Canada. Semi-structured interviews with participants aged 15 - 24 explored the relationship between UTB constructs and service use. Youth and parent advisory teams were engaged in the research process. Analysts used content analysis methodology to develop a taxonomy of the top categories for each construct. RESULTS: Categories with the most salient and rich content were reported for each construct. The impact of emotions on service use was most commonly discussed in relation to the framework. The UTB constructs 'self-efficacy' and 'knowledge' were found to be interrelated. Differences in UTB categories emerged by symptom severity. Findings pointed towards a dynamic nature of service use, whereby service use experiences, may lead youth to consider future decisions surrounding service use within Foundry. CONCLUSIONS: This study contributes to a new understanding of integrated youth services utilization. The results can help shape the development of interventions to increase service access and retention, in addition to informing the design of systems of care that are accessible to all.

OBJECTIF: En tenant compte de ce que le développement de 75 % des troubles de santé mentale a lieu avant l'âge de 25 ans, il est alarmant que l'utilisation des services chez les jeunes soit si faible. Peu de recherche menée théoriquement a exploré le processus décisionnel que font les jeunes quand ils accèdent à des services. La présente étude a utilisé un cadre décisionnel, la théorie unifiée du comportement (TUC), pour comprendre l'utilisation des services chez les jeunes qui fréquentent Foundry, un réseau de centres de services intégrés pour les jeunes, conçu pour soutenir la santé et le bien-être des jeunes. MÉTHODES: Quarante-et-un participants ont été recrutés dans un centre Foundry d'une communauté urbaine du Canada. Des interviews semi-structurées de participants de 15 à 24 ans ont exploré la relation entre les concepts TUC et l'utilisation des services. Les équipes de consultation jeunes-parents étaient engagées au processus de recherche. Les analystes ont utilisé la méthodologie de l'analyse du contenu pour développer une taxonomie des meilleures catégories pour chaque notion. RÉSULTATS: Les catégories ayant le contenu le plus saillant et le plus riche ont été rapportées pour chaque notion. L'effet des émotions sur l'utilisation des services était le plus souvent discuté en relation au cadre. Les notions « auto-efficacité ¼ et « connaissance ¼ de la TUC ont été jugées inter-reliées. Les différences dans les catégories TUC ont émergé par la gravité des symptômes. Les résultats indiquaient une nature dynamique de l'utilisation des services, par laquelle les expériences d'utilisation des services peuvent mener les jeunes à considérer de futures décisions concernant l'utilisation des services dans Founndry. CONCLUSIONS: La présente étude contribue à une nouvelle compréhension de l'utilisation des services intégrés pour les jeunes. Les résultats peuvent aider à donner forme au développement d'interventions afin d'accroître l'accès aux services et la rétention de ceux-ci, en plus d'éclairer la conception de systèmes de soins accessibles à tous.

A Systematic Review of Shared Decision-Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future Directions.

OBJECTIVE: Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS: Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors. RESULTS: Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs. CONCLUSIONS: Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness.

Promoting "Zest for Life": A Systematic Literature Review of Resiliency Factors to Prevent Youth Suicide.

Suicide is a leading cause of death among youth globally. In this critical interpretive synthesis, we examined literature on resiliency factors and suicidality. Systematic searches identified 474 articles, 37 of which were included. Results revealed internal (positive self-appraisal, zest for life, personal traits, and coping skills) and external factors (social support system and inclusive environments) contribute to resilience among youth, with age, sex and gender, and Indigenous identity as important intersecting considerations. Findings validated fostering resilience as primary suicide prevention among youth, with little explanation for how these factors may work to protect youth from suicidality. Continued research in this area requires a focus on how to promote resilience at the community and systems levels.

Perspectives on personal identity in the early stages of psychosis: A survey of Canadian clinicians.

AIM: Identity-related concerns represent an important aspect of young people's experience in early psychosis. Knowledge regarding clinicians' perspectives on this issue, however, is limited. Thus, the present study was developed to understand Canadian clinicians' perspectives on personal identity-related concerns in early psychosis. METHODS: An online survey was distributed to 331 multiprofessional clinicians working in early psychosis intervention programs in a Canadian province. Clinicians were asked about their opinions regarding the salience of identity in early psychosis using Likert-rated items and open response questions. RESULTS: Nearly all of the clinicians agreed that identity is an important issue for clinical attention, yet only half of the clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment. Although several clinical strategies were identified, specific evidence-based approaches for strengthening identity in early psychosis remain lacking. CONCLUSIONS: Findings indicate a need for early psychosis programs to invest in identity- related training for clinicians.

INNOVATE Research: Impact of a workshop to develop researcher capacity to engage youth in research.

BACKGROUND: Engaging youth in research provides substantial benefits to research about youth-related needs, concerns and interventions. However, researchers require training and capacity development to work in this manner. METHODS: A capacity-building intervention, INNOVATE Research, was co-designed with youth and adult researchers and delivered to researchers in three major academic research institutions across Canada. Fifty-seven attendees participated in this research project evaluating youth engagement practices, attitudes, perceived barriers, and perceived capacity development needs before attending the intervention and six months later. RESULTS: The intervention attracted researchers across various career levels, roles and disciplines. Participants were highly satisfied with the workshop activities. Follow-up assessments revealed significant increases in self-efficacy six months after the workshop (P = .035). Among possible barriers to youth engagement, four barriers significantly declined at follow-up. The barriers that decreased were largely related to practical knowledge about how to engage youth in research. Significantly more participants had integrated youth engagement into their teaching activities six months after the workshop compared to those who were doing so before the workshop (P = .007). A large proportion (71.9%) of participants expressed the need for a strengthened network of youth-engaged researchers; other future capacity-building approaches were also endorsed. CONCLUSIONS: The INNOVATE Research project provided improvements in youth engagement attitudes and practices among researchers, while lifting barriers. Future capacity-building work should continue to enhance the capacity of researchers to engage youth in research. Researchers notably pointed to the need to establish a network of youth-engaged researchers to provide ongoing, sustainable gains in youth engagement.

Enhancing researcher capacity to engage youth in research: Researchers' engagement experiences, barriers and capacity development priorities.

BACKGROUND: There is increasing emphasis on engaging youth in research about youth, their needs, experiences and preferences, notably in health services research. By engaging youth as full partners, research becomes more feasible and relevant, and the validity and richness of findings are enhanced. Consequently, researchers need guidance in engaging youth effectively. This study examines the experiences, needs and knowledge gaps of researchers. METHODS: Eighty-four researchers interested in youth engagement training were recruited via snowball sampling. They completed a survey regarding their youth engagement experiences, attitudes, perceived barriers and capacity development needs. Data were analysed descriptively, and comparisons were made based on current engagement experience. RESULTS: Participants across career stages and disciplines expressed an interest in increased capacity development for youth engagement. They had positive attitudes about the importance and value of youth engagement, but found it to be complex. Participants reported requiring practical guidance to develop their youth engagement practices and interest in a network of youth-engaged researchers and on-going training. Those currently engaging youth were more likely to report the need for greater appreciation of youth engagement by funders and institutions. CONCLUSIONS: Engaging youth in research has substantial benefits. However, skills in collaborating with youth to design, conduct and implement research have to be learned. Researchers need concrete training and networking opportunities to develop and maximize these skills. They also need mechanisms that formally acknowledge the value of engagement. Researchers and those promoting youth engagement in research are encouraged to consider these findings in their promotion and training endeavours.

Understanding the mental health and recovery needs of Canadian youth with mental health disorders: a Strategy for Patient-Oriented Research (SPOR) collaboration protocol.

BACKGROUND: While considerable progress is being made to understand the health and self-management needs of youth with mental health disorders, little attention has focused on the mental health and recovery needs that the youth themselves identify-this despite a national priority to incorporate patient-oriented research into the development and assessment of mental health services. To address this gap, estimates of the extent to which existing patient-reported outcome measures (PROMs)-originally developed for use amongst adult populations-are clinically meaningful and psychometrically fit for use among youth are needed. In tandem, a recovery profile for youth can be constructed incorporating the youth perspective of the services provided within a community mental health setting. METHODS/DESIGN: This study will utilize a mixed methods design incorporating qualitative focus group interviews and cross-sectional survey. Our process will begin with the hiring of a youth peer research partner who will provide lived experience expertise through all phases of the study. We will advertise, recruit, and conduct four focus groups with youth who receive services from the Foundry Vancouver Granville located in British Columbia, Canada. In the first two focus groups, we will recruit youth aged 15-18 years (n = 10). In the second two focus groups, we will recruit young adults aged 19-24 years (n = 10). In parallel, we will conduct a cross-sectional survey of the recovery and mental health needs of youth, informed by ten widely used and validated PROM. Thematic analysis techniques will guide the identification of predominant thematic trends in the qualitative focus group data. We will use Classical and Rasch measurement methods to test and analyze the reliability and validity of selected PROM measures for youth populations. DISCUSSION: The proposed study has the potential to produce a preliminary conceptual and measurement model for understanding the mental health and recovery needs of youth with mental health disorders. This evidence will inform how youth mental health services can grow, support, and sustain the capacity for a collaborative, interdisciplinary and innovative patient-oriented research environment. Findings will also contribute much needed evidence to improve the standard of care for youth who experience mental health disorders in Canada and beyond.

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).

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).

Sleep disturbances in individuals at clinical high risk for psychosis.

There has been recent interest in understanding the role that sleep disturbance plays in patients at Clinical High Risk for psychosis (CHR). We assessed sleep disturbance in 194 CHR patients and 66 healthy control subjects and their relationship to symptoms (positive, negative and general functioning). Patients experienced significantly more sleep disturbance than healthy control subjects and their sleep disturbance was related to greater positive and negative symptoms and worse overall functioning. Targeting sleep disturbance in CHR individuals may provide alternative means of treating the CHR syndrome.

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.

Social inference in individuals at clinical high risk for psychosis.

AIM: Social cognition impairment is a hallmark of schizophrenia and contains multiple domains. The domain of social inference has been relatively understudied in schizophrenia and its risk states. METHODS: Social inference was assessed in 60 clinical high-risk (CHR) patients and 28 healthy control subjects, using the video social inference task. We hypothesized a deficit in social inference in CHR participants and examined predictive value for psychosis transition. RESULTS: Social inference was positively associated with increasing age. Social inference did not differ significantly between CHR patients and controls, or predict transition to psychosis. CONCLUSIONS: Few studies have examined social inference of individuals at clinical high risk for psychosis, and findings have been inconclusive. Additional studies using a variety of measures of social inference in CHR participants are recommended.

Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.

BACKGROUND: Despite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma. METHODS: Thirty-eight CHR subjects were ascertained using standard measures from the Center of Prevention and Evaluation/New York State Psychiatric Institute/ Columbia University. Labeling-related measures adapted to the CHR group included "stereotype awareness and self-stigma" ("Stereotype awareness", "Stereotype Agreement", "Negative emotions [shame]"), and a parallel measure of "Negative emotions (shame)" for symptoms. These measures were examined in relation to symptoms of anxiety and depression, adjusting for core CHR symptoms (e.g. attenuated psychotic symptoms). RESULTS: CHR participants endorsed awareness of mental illness stereotypes, but largely did not themselves agree with these stereotypes. Furthermore, CHR participants described more stigma associated with symptoms than they did with the risk-label itself. Shame related to symptoms was associated with depression, while shame related to the risk-label was associated with anxiety. CONCLUSION: Both stigma of the risk-label and of symptoms contribute to the experience of CHR individuals. Stereotype awareness was relatively high and labeling-related shame was associated with increased anxiety. Yet limited agreement with stereotypes indicated that labeling-related stigma had not fully permeated self-conceptions. Furthermore, symptom-related stigma appeared more salient overall and was linked with increased depression, suggesting that alleviating symptom-related shame via treating symptoms might provide major benefit.