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

申请人通过F31 Kirschstein-NRSA博士前个人奖学金申请两年的资金，以进行混合方法研究的培训，解决一线病例管理者对无家可归的成年人中同时发生的精神病和药物使用障碍的恢复观点。申请人在这一人群中的临床背景，沿着他目前在R 01资助的这一人群服务研究中担任研究助理，使他非常适合从事这一主题。本培训提案的主要目标是培养完成独立提出的研究所需的技能和专业知识，为更大的R 01研究的分析做出贡献，并为继续研究有效的精神卫生服务提供奠定基础。申请人将通过正式的课程，导师辅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。这项独立建议的研究将探讨41名个案经理的意见，他们几乎平均分为“住房优先”和“治疗优先”的方法。该数据集将反映“真实的时间”消费者提供者的关系，通过个案经理访谈以及访谈他们的客户83。大多数分析将是定性的，包括案例研究和扎根理论方法。从个案经理和消费者收集的措施的定量分析将增加这些发现。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）制定个案管理者对参与和脱离服务的理解，3）为患有共同发生的疾病的无家可归成年人制定一个以康复为导向的实践模式。总的来说，这项研究旨在解决一线提供者对被认为难以参与的人群的治疗方法的看法。此外，这一人群尚未明确涉及或完全纳入通过地方和国家精神卫生政策大力推动的新的严重精神疾病康复愿景。如果考虑到向这些弱势群体提供有效服务取决于最终执行做法和政策的人-一线工作人员，那么，这项研究议程与公共卫生的相关性就很明显。

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.