A Qualitative Study of Dual-Diagnosed Homeless

描述(由申请人提供)：精神残疾无家可归的成年人(PDHA)过着复杂的、麻烦的生活。虽然已经写了很多关于他们需求的文章，但从服务用户的角度进行的研究几乎是未知的。我们的目标是开发一种社会生态模型，解决由两种不同方法并存而产生的鲜为人知的“过程”问题：“治疗优先”和“住房优先”。哪些因素--基于个人的和背景相关的--阻碍或加强了参加这两种计划模式的PDHA在护理方面的参与度和保留率？我们建议使用定性的方法和一个跨学科的研究团队，从原住民的角度来调查服务交付系统。具体目标是：1)使用案例研究方法(N-40)，绘制以前参加过两个不同计划的PDHA的“成功”和“不成功”的生命历程轨迹；2)对参加“住房优先”计划和“治疗优先”计划的PDHA进行纵向研究，以了解当计划理念和实践根本不同时，参与和保持护理的程度是如何变化的。这一目标将通过两种方式实现：a)一项前瞻性研究，对纽约市为PDHA服务的三个方案的80名参与者进行为期一年的跟踪；b)深入访谈PDHA的服务提供商，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的病例经理(n=80)、3个方案地点的病例经理焦点小组(n=30)、以及为PDHA提供服务的经验丰富的专业人员(n=10)；3)具体说明服务提供的可行改变，从而导致PDHA成功参与并保留在精神疾病和共病药物滥用护理中。将召集专家小组，讨论这项研究的结果，以提出改进方案/政策的建议，并查明执行方面的障碍。我们的最终目标是将经验发现转化为可复制的政策和做法，以加强对这一“难以接触到的”人群的外联和服务提供。

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.