Integrated Health Care for African Americans with Mental Illness Who Are Homeless

描述(申请人提供)：无家可归的人身体疾病的发病率和流行率很高，同时发生的严重精神疾病进一步加剧了这种疾病。非洲裔美国人受到无家可归的影响不成比例，多达50%的无家可归者是非洲裔美国人。在伊利诺伊州，无家可归的人口正在增加，预计将增加5%。在芝加哥，2006-2010年间，避难所使用率上升了28.4%，无避难所使用率飙升至40.4%。一个受影响尤其严重的社区是埃奇沃特住宅区，那里的无家可归者患有精神疾病的比例在全国名列前茅。尽管为这一群体提出和制定了综合护理方案，但它们的影响有限，部分原因是它们没有在发展和执行中充分纳入无家可归者的声音。因此，我们提出了一个基于社区的参与性研究(CBPR)项目，旨在针对患有严重精神疾病的无家可归的非裔美国人的医疗保健需求。与该小组进行的初步需求评估有助于指导这项建议。我们将建立一个社区咨询委员会(CAB)，由有生活经验的非裔美国人组成，并由包括一名有生活经验的非裔美国人在内的共同私人投资机构共同担任主席。CAB将对这项提案的所有方面拥有控制权。为了确定问题，我们将对有生活经验的人和其他利益相关者进行定性采访，然后在定量调查中与第二组交叉验证这些信息。CAB将使用这些信息来设计使用综合护理模式的干预措施。随后将在试点评估中测试干预措施的可行性、可接受性和影响。结果将包括对感知可用性、计划满意度、身心健康和纵向设计生活质量的评估(例如，基线、中点和随访)。 相关性(见说明)：患有严重精神疾病的无家可归的非裔美国人的发病率和死亡率达到灾难性水平。通过以社区为基础的参与性研究，我们将确定芝加哥埃奇沃特-住宅区这一人群的具体健康问题，并制定旨在促进那里综合保健的整合。该项目还将包括对这一干预措施的可接受性和影响进行试点调查。

DESCRIPTION (provided by applicant): People who are homeless have high incidence and prevalence of physical illnesses that are further exacerbated by co-occurring serious mental illnesses. African Americans are disproportionately affected by homelessness with as many as 50 percent of homeless people being African American. In Illinois, the homeless population is increasing and expected to rise 5 percent. In Chicago from 2006-2010, shelter use rose 28.4 percent and those unsheltered surged to 40.4 percent. One neighborhood especially hard hit is the Edgewater-Uptown area with among the highest rate of homeless people with co-occurring mental illness in the country. Although integrated care programs have been proposed and developed for this population, they have limited impact in part because they have not fully incorporated the voice of the homeless in development and implementation. Hence, we propose a community based participatory research (CBPR) project meant to target the health care needs of African Americans who are homeless with serious mental illness. A preliminary needs assessment with the group has helped to direct this proposal. We will establish a Community Advisory Board (CAB) comprised of African Americans with lived experience and co-chaired by the co-PIs including an African American with lived experience. The CAB will have control over all aspects of this proposal. To define the problem, we will conduct qualitative interviews of people with lived experience and other stakeholders and then cross-validate this information with a second group in a quantitative survey. The CAB will use this information to design an intervention using an integrated care model. Feasibility, acceptability, and impact of the intervention will then be tested in a pilot evaluation. Outcomes will include assessments of perceived availability, program satisfaction, physical and mental health, and quality of life with longitudinal design (e.g., baseline, midpoint, and follow-up). RELEVANCE (See Instructions): African Americans who are homeless with serious mental illness suffer a catastrophic level of morbidity and mortality. Through community based participatory research, we will identify specific health concerns of this population in Chicago's Edgewater-Uptown neighborhood and develop an integration meant to promote integrated care therein. The project will also include a pilot investigation of the acceptability and impact of thi intervention.