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（PDHA）导致复杂，麻烦的生活。虽然已经写了很多关于他们的需求，从服务用户的角度来看，研究仍然几乎是未知的。我们的目标是开发一个社会生态学模型，解决两种不同的方法并置所带来的理解不深的“过程”问题：“治疗第一”与“住房第一”。哪些因素--基于个人的和背景的--阻碍或增强了参加这两种计划模式的PDHA在护理中的参与和保留？我们建议使用定性的方法和跨学科的研究团队来调查的服务提供系统从“本地人的观点”。具体目标是：1）使用案例研究方法（N-40）绘制先前参加两个对比项目的PDHA参与和保留护理的“成功”与“不成功”的生命历程轨迹; 2）对参加“住房第一”与“治疗第一”项目的PDHA进行纵向研究，以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如何变化。这一目标将通过两种方式来实现：a）一项前瞻性研究，其中80名注册者在纽约市的PDHA服务的三个程序中被跟踪一年; 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。供应商包括：R的个案经理（n=80），个案经理焦点小组在3个项目地点（n=30），和有经验的专业人士服务PDHA（n=10）; 3）指定可行的变化，在提供服务，将导致成功的参与和保留的PDHA在照顾精神疾病和共病药物滥用。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，并确定执行的障碍。我们的最终目标是将经验研究结果转化为可复制的政策和做法，以加强对这一“难以接触”人口的外联和服务提供。

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.