This application presents a program of research and training that focuses on the factors of housing environments that are critical for adaptive functioning in community settings for persons with serious mental illness (SMI). The objectives of this proposal are (a) to develop the PI?s expertise in the assessment of adaptive functioning of persons with SMI living in community settings and (b) to test a model, developed by the PI of housing environment factors that promote adaptive functioning. The model examines how (1) housing environment, (2) personal characteristics, and (3) behavioral health symptoms interact to affect adaptive functioning. Housing environment factors are conceptualized as consisting of three components: physical environment, social environment, and interpersonal relationships associated with housing (e.g., landlords & neighbors). Personal characteristics relevant to housing experience include: gender, ethnicity/race, income, homelessness history, and social support. The training will be supervised by Robert E. Drake, MD, Ph.D. and will take place at the New Hampshire-Dartmouth Psychiatric Research Center and Yale University, Department of Psychiatry, Division of Prevention and Community Research. The proposed study will be conducted at a large, urban mental health center operated by the Yale University Department of Psychiatry in which co-sponsors Dr. Snow and Dr. Tebes have senior leadership roles. Three hundred clients will participate in a longitudinal study of the influence of their housing environments on their adaptive functioning. Half of the sample will have their own apartments through supported housing programs; 150 clients will be matched comparisons who also have their own apartments but do not participate in housing programs. Each research participant will complete a baseline interview of current adaptive functioning in community settings and a follow-up interview 12 months after baseline. Assessment of functioning will include indices of (a) residential tenure, (b) crisis service use, (c) social role functioning, (d) community involvement, and (e) quality of life. Structural Equation Modeling will be used to test the model. I expect that the career award will enable me to refine my model and will lay the groundwork for a career investigating the risk and protective factors of community-based living.
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