The applicant requests two years of funding through a F31 Kirschstein-NRSA Predoctoral Individual Fellowship to pursue training in mixed methods research addressing front-line case managers' views of recovery among homeless adults with co-occurring psychiatric and substance use disorders. The applicant's clinical background with this population, along with his current involvement as a research assistant in a R01-funded study of services for this population, makes him ideally suited to pursue this topic. The broad objectives of this training proposal are to develop the skills and expertise necessary to complete an independently-proposed study, contribute to the analyses of the larger R01 study, and provide a foundation for continued research on effective mental health service delivery. The applicant will pursue training through formal coursework, mentorship tutorials, and practical application of qualitative and quantitative methods as part of the larger study. The independently-proposed research study will examine the views of 41 case managers who are almost evenly divided between a """"""""housing first"""""""" approach and a """"""""treatment first"""""""" approach. The data set will reflect """"""""real time"""""""" consumer-provider relationships through case manager interviews as well as interviews from 83 of their clients. The majority of the analyses will be qualitative including both case study and grounded theory approaches. Quantitative analysis of measures collected from case managers and consumers will augment these findings.
The specific aims of the study include: 1) delineating case managers' views of recovery principles, 2) formulating case managers' understanding of engagement and disengagement in services, and 3) developing an empirically-based model of recovery-oriented practices for homeless adults with co-occurring disorders. Overall, this research is intended to address front-line provider perspectives of treatment approaches with a population that is considered difficult to engage. In addition, this population has not been clearly implicated or fully included in the new-found vision of recovery from serious mental illness that is being vigorously promoted through local and national mental health policies. This research agenda's relevance to public health is clear when one considers that effective service delivery for such vulnerable populations is dependent on those who ultimately implement practice and policy - the front-line workers. ? ? ?
