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.
The study will generate evidence to support the implementation of recovery-oriented practices in supportive housing programs, an approach that seeks to improve the quality of care for people with severe mental illnesses. With public health relevance for this high-need, high-service utilizing population, this study will examine barriers t recovery-oriented practices in diverse and complex real world service environments that are further complicated by limited financial resources.