Examining Case Managers' Views of Recovery Among Dually Diagnosed Homeless Adults

描述（由申请人提供）：申请人要求通过F31 Kirschstein-NRSA博士前个人奖学金获得两年的资助，以进行混合方法研究的培训，解决一线病例管理人员对同时发生精神和物质使用障碍的无家可归成年人康复的看法。申请人与这一人群的临床背景，以及他目前作为研究助理参与了r01资助的一项针对这一人群的服务研究，使他非常适合从事这一主题。该培训计划的主要目标是培养完成独立研究所需的技能和专业知识，为更大的R01研究的分析做出贡献，并为有效提供心理健康服务的持续研究奠定基础。申请人将通过正式的课程学习、导师指导以及定性和定量方法的实际应用来进行培训，作为更大研究的一部分。这项独立提出的研究将考察41位病例管理人员的观点，他们几乎平分为“住房优先”和“治疗优先”两派。该数据集将通过案例经理的访谈以及83个客户的访谈，反映“实时的”消费者与供应商之间的关系。大多数分析将是定性的，包括案例研究和扎根理论方法。对从病例管理人员和消费者那里收集的措施进行定量分析将增强这些发现。本研究的具体目的包括：1)描述个案管理者对康复原则的看法；2)制定个案管理者对服务参与和脱离的理解；3)为患有共同发病的无家可归成年人建立基于经验的康复实践模型。总的来说，这项研究旨在解决一线提供者对治疗方法的看法，这些治疗方法被认为是难以参与的。此外，地方和国家精神卫生政策大力提倡的新发现的严重精神疾病康复愿景并未明确涉及或完全包括这一人群。考虑到为这些弱势群体提供有效的服务取决于最终实施实践和政策的人——一线工作人员，这一研究议程与公共卫生的相关性是显而易见的。

DESCRIPTION (provided by applicant): The applicant requests two years of funding through a F31 Kirschstein-NRSA Predoctoral Individual Fellowship to pursue training in mixed methods research addressing front-line case managers' views of recovery among homeless adults with co-occurring psychiatric and substance use disorders. The applicant's clinical background with this population, along with his current involvement as a research assistant in a R01-funded study of services for this population, makes him ideally suited to pursue this topic. The broad objectives of this training proposal are to develop the skills and expertise necessary to complete an independently-proposed study, contribute to the analyses of the larger R01 study, and provide a foundation for continued research on effective mental health service delivery. The applicant will pursue training through formal coursework, mentorship tutorials, and practical application of qualitative and quantitative methods as part of the larger study. The independently-proposed research study will examine the views of 41 case managers who are almost evenly divided between a "housing first" approach and a "treatment first" approach. The data set will reflect "real time" consumer-provider relationships through case manager interviews as well as interviews from 83 of their clients. The majority of the analyses will be qualitative including both case study and grounded theory approaches. Quantitative analysis of measures collected from case managers and consumers will augment these findings. The specific aims of the study include: 1) delineating case managers' views of recovery principles, 2) formulating case managers' understanding of engagement and disengagement in services, and 3) developing an empirically-based model of recovery-oriented practices for homeless adults with co-occurring disorders. Overall, this research is intended to address front-line provider perspectives of treatment approaches with a population that is considered difficult to engage. In addition, this population has not been clearly implicated or fully included in the new-found vision of recovery from serious mental illness that is being vigorously promoted through local and national mental health policies. This research agenda's relevance to public health is clear when one considers that effective service delivery for such vulnerable populations is dependent on those who ultimately implement practice and policy - the front-line workers.