Psychiatrically disabled homeless adults (PDHAs) lead complex, troubled lives. Although much has been written about their needs, research from the service user's perspective remains virtually unknown. Our goal is to develop a social ecology model that addresses poorly understood 'process' questions posed by the juxtaposition of two distinct approaches: 'treatment first' vs. 'housing first'. What factors--person-based and contextual--impede or enhance engagement and retention in care among PDHAs enrolled in these two program models? We propose to use qualitative methods and an interdisciplinary research team to investigate the service delivery system from the 'native's point of view'.
Specific aims are: 1) To map 'successful' vs. 'unsuccessful' life course trajectories of engagement and retention in care among PDHAs previously enrolled in two contrasting programs using case study methods (N--40); 2) To conduct a longitudinal study of PDHAs enrolled in 'housing first' vs. 'treatment first' programs to learn how engagement and retention in care vary when program philosophies and practices fundamentally differ.
This aim will be accomplished in two ways: a) a prospective study in which 80 enrollees in three programs serving PDHAs in New York City are followed for one year; b) in-depth interviews with service providers for PDHAs to identify areas of congruence/non-congruence with consumer self-reports and perspectives. Providers include: R's case managers (n=80), case manager focus groups at the 3 program sites (n=30), and experienced professionals serving PDHAs (n=10); 3) To specify viable changes in delivery of services that would result in successful engagement and retention of PDHAs in care for mental illness and co-morbid substance abuse. Expert panels will be convened in which findings from this study are discussed to develop suggestions for program/policy improvements and identify barriers to implementation. Our ultimate goal is to translate empirical findings into replicable policies and practices that will enhance outreach and service delivery for this 'hard-to-reach' population.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-CRB-M (01))
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Juliano-Bult, Denise M
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New York University
Schools of Social Work
New York
United States
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Stanhope, Victoria; Choy-Brown, Mimi; Tiderington, Emmy et al. (2016) Case Manager Perspectives on the Role of Treatment in Supportive Housing for People with Severe Mental Illness. J Soc Social Work Res 7:507-525
Henwood, Benjamin F; Derejko, Katie-Sue; Couture, Julie et al. (2015) Maslow and mental health recovery: a comparative study of homeless programs for adults with serious mental illness. Adm Policy Ment Health 42:220-8
Henwood, Benjamin F; Stefancic, Ana; Petering, Robin et al. (2015) Social Relationships of Dually Diagnosed Homeless Adults Following Enrollment in Housing First or Traditional Treatment Services. J Soc Social Work Res 6:385-406
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Padgett, Deborah K; Henwood, Ben; Abrams, Courtney et al. (2008) Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: voices from the margins. Psychiatr Rehabil J 31:226-33
Hawkins, Robert Leibson; Abrams, Courtney (2007) Disappearing acts: the social networks of formerly homeless individuals with co-occurring disorders. Soc Sci Med 65:2031-42
Padgett, Deborah K (2007) There's no place like (a) home: ontological security among persons with serious mental illness in the United States. Soc Sci Med 64:1925-36

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