A Qualitative Study of Dual-Diagnosed Homeless

描述（由申请人提供）：精神残疾的无家可归的成年人（PDHAs）过着复杂而烦恼的生活。虽然关于他们的需求已经写了很多，但从服务用户的角度进行的研究实际上仍然未知。我们的目标是开发一种社会生态学模型，以解决由两种不同方法（“治疗优先”和“治疗优先”）并置于一起所提出的难以理解的“过程”问题。“住房第一”。哪些因素——以人为本的因素和环境因素——阻碍或增强了注册这两种项目模式的pdha对护理的参与和保留？我们建议使用定性方法和一个跨学科的研究团队，从“当地人的角度”调查服务提供系统。具体目标是：1)将“成功”与“失败”进行对比。使用案例研究方法，在之前参加过两个对比项目的pdha中，参与和保留护理的“不成功”生命历程轨迹（N- 40）；2)对参加“住屋优先”vs.的pdha进行纵向研究。“治疗优先”项目，了解当项目理念和实践根本不同时，参与和保留护理的情况是如何变化的。这一目标将通过两种方式实现：a)一项前瞻性研究，对纽约市三个为pdha服务的项目的80名参与者进行为期一年的跟踪研究；b)与pdha服务提供商进行深入访谈，以确定与消费者自我报告和观点一致/不一致的领域。提供者包括：R的病例管理人员（n=80）， 3个项目站点的病例管理人员焦点小组（n=30），以及为pdha服务的经验丰富的专业人员（n=10）；3)具体说明在提供服务方面可行的变化，这些变化将导致pdha在精神疾病和共病药物滥用护理方面的成功参与和保留。将召开专家小组会议，讨论这项研究的结果，以提出改进方案/政策的建议，并确定实施的障碍。我们的最终目标是将实证研究结果转化为可复制的政策和实践，以加强对这一“难以接触”人口的推广和服务提供。

DESCRIPTION (provided by applicant): Psychiatrically disabled homeless adults (PDHAs) lead complex, troubled lives. Although much has been written about their needs, research from the service user's perspective remains virtually unknown. Our goal is to develop a social ecology model that addresses poorly understood 'process' questions posed by the juxtaposition of two distinct approaches: 'treatment first' vs. 'housing first'. What factors--person-based and contextual--impede or enhance engagement and retention in care among PDHAs enrolled in these two program models? We propose to use qualitative methods and an interdisciplinary research team to investigate the service delivery system from the 'native's point of view'. Specific aims are: 1) To map 'successful' vs. 'unsuccessful' life course trajectories of engagement and retention in care among PDHAs previously enrolled in two contrasting programs using case study methods (N--40); 2) To conduct a longitudinal study of PDHAs enrolled in 'housing first' vs. 'treatment first' programs to learn how engagement and retention in care vary when program philosophies and practices fundamentally differ. This aim will be accomplished in two ways: a) a prospective study in which 80 enrollees in three programs serving PDHAs in New York City are followed for one year; b) in-depth interviews with service providers for PDHAs to identify areas of congruence/non-congruence with consumer self-reports and perspectives. Providers include: R's case managers (n=80), case manager focus groups at the 3 program sites (n=30), and experienced professionals serving PDHAs (n=10); 3) To specify viable changes in delivery of services that would result in successful engagement and retention of PDHAs in care for mental illness and co-morbid substance abuse. Expert panels will be convened in which findings from this study are discussed to develop suggestions for program/policy improvements and identify barriers to implementation. Our ultimate goal is to translate empirical findings into replicable policies and practices that will enhance outreach and service delivery for this 'hard-to-reach' population.