Identifying Barriers to Recovery-Oriented Practice in Supportive Housing Services

描述(由申请人提供)：患有精神和药物使用障碍的无家可归成年人仍然是一个高度脆弱的群体，他们在急诊室、医院、庇护所和监狱逗留方面积累了不成比例的高成本。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扰乱这种“制度循环”。由于精神健康康复现已被联邦政府认可为美国精神卫生系统根本性变革的“唯一最重要目标”，针对这一人群的服务(包括支持性住房)肩负着实施以康复为导向的做法的任务。尽管有相当多的证据表明这种做法在改善个人成果方面有好处，但尚未得到广泛采用，关于将这种做法纳入无家可归者服务的执行战略的实证研究仍然非常缺乏。拟议的F31将为一名承诺的、具有临床经验的博士申请人做好准备，以进行混合方法研究，重点是确定和检查在服务于双重诊断的无家可归成年人的支持性住房环境中以恢复为导向的做法的障碍。由于一线服务提供商在服务规划方面拥有相当大的自由裁量权，以及机构层面的因素，如气候和文化可能会影响服务的提供，因此本研究将使用开放系统理论、组织理论和创新扩散理论为指导的理论框架。混合方法办法将从多个层面的分析中阐明在支持性住房服务中采用注重恢复的做法的潜在调解人。研究的第一阶段将通过对一线提供者的深入定性访谈以及对组织日常运作的人种学观察，捕捉以恢复为导向的做法的“现实世界”障碍。研究的第二阶段将采用定量调查方法，以便从前线和高层行政/监督工作人员那里更广泛地了解提供者对支持性住房中注重恢复的做法的障碍。综上所述，调查结果将被用来为制定新的干预措施或调整现有干预措施提供信息，以改进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.