Identifying Barriers to Recovery-Oriented Practice in Supportive Housing Services

描述（由申请人提供）：同时患有精神和物质使用障碍的无家可归的成年人仍然是高度脆弱的人群，他们在急诊室、医院、庇护所和监狱停留期间积累了不成比例的高费用。支持性住房是一种以社区为基础的护理模式，旨在通过帮助个人满足住房和其他需求来打破这种“体制循环”。由于心理健康康复现在已经被联邦政府认可为美国心理健康系统根本性变革中的“唯一最重要的目标”，针对这一人群（包括支持性住房）的服务机构承担着实施康复导向实践的任务。尽管有大量证据表明这种方法在改善个人结果方面的好处，但尚未得到广泛采用，而且关于将这种方法纳入无家可归者服务的实施策略的实证研究仍然非常缺乏。拟议中的F31将准备一名忠诚的、临床经验丰富的博士申请人，进行混合方法研究，重点是识别和检查在支持性住房环境中为双重诊断的无家可归的成年人提供康复导向实践的障碍。由于一线供应商在服务规划和机构层面的因素（如气候和文化）中保留了相当大的自由裁量权，因此将使用开放系统理论、组织理论和创新扩散理论为理论框架来指导研究。混合方法方法将从多个层面分析阐明在支持性住房服务中采用以恢复为导向的做法的潜在调节因素。研究的第一阶段将通过对一线医疗服务提供者进行深入的定性访谈，以及对组织日常运营的民族志观察，捕捉“现实世界”中以康复为导向的实践的障碍。研究的第二阶段将采用定量调查方法，以更广泛地了解一线和上层行政/监督人员对提供者认为的在支持性住房中以康复为导向的做法存在的障碍。综上所述，研究结果将用于为制定新的或调整现有干预措施提供信息，以改善在支持性住房环境中实施以恢复为导向的做法。

DESCRIPTION (provided by applicant): Homeless adults with co-occurring psychiatric and substance use disorders remain a highly vulnerable population that accumulates disproportionately high costs in emergency room, hospital, shelter and jail stays. Supportive housing, a community-based model of care, seeks to disrupt this 'institutional circuit' by assisting individuals in meeting housing and other needs. As mental health recovery has now been endorsed by the Federal government as the "single most important goal" in the fundamental transformation of the mental health system in the United States, services targeting this population (including supportive housing) are charged with the task of implementing recovery-oriented practices. Despite considerable evidence pointing to the benefits of this approach in improving individual outcomes, widespread adoption has yet to occur and there remains a significant dearth of empirical research regarding implementation strategies for integrating this approach into homeless services. The proposed F31 will prepare a committed, clinically experienced doctoral applicant to conduct mixed methods research focused on identifying and examining barriers to recovery-oriented practices in supportive housing settings serving dually-diagnosed homeless adults. As front-line providers retain considerable discretion in service planning and agency-level factors, such as climate and culture can influence the provision of services, a theoretical framework informed by Open System Theory, Organizational Theory, and the theories of Diffusion of Innovations will be used to guide the study. The mixed methods approach will elucidate potential moderators to the adoption of recovery-oriented practices within supportive housing services from multiple levels of analysis. The first phase of the study will capture the 'real world' barriers to recovery-oriented practices through in-depth qualitative interviews with front-line providers, as well as ethnographic observations of organizational day-to-day operations. The second phase of the study will employ quantitative survey methodology to gain a broader understanding of provider-perceived barriers to recovery- oriented practices in supportive housing from both front-line and upper-level administrative/supervisory staff. Taken together, the findings will be used to inform the development of new or tailoring of existing interventions to improve the implementation of recovery-oriented practices within supportive housing settings.