From Structural Chaos to a Model of Consumer Support: Understanding the Roles of Structure and Agency in Mental Health Recovery for the Formerly Homeless

Deinstitutionalization shifted the focus in mental health care from provider-guided treatment to consumer-centered recovery. In this article, I seek to develop a deeper understanding of the effect that the organization of mental health services offered in community settings has on the recovery process. I do this by presenting findings from the analysis of focus group and interview data collected from consumers and staff at four housing programs serving formerly homeless individuals with dual diagnosis. My findings highlight the importance of understanding the connection that exists between social structure and personal agency and the recovery process

The Meaning of Recovery from Co-Occurring Disorder: Views from Consumers and Staff Members Living and Working in Housing First Programming

The current study seeks to understand the concept of recovery from the perspectives of consumers and staff living and working in a supportive housing model designed to serve those with co-occurring disorder. Interview and focus group data were collected from consumers and staff from four housing programs. Data analyzed using an approach that combined case study and grounded theory methodologies demonstrate that: consumers’ and staff members’ views of recovery were highly compatible and resistant to abstinence-based definitions of recovery; recovery is personal; stability is a foundation for recovery; recovery is a process; and the recovery process is not linear. These themes are more consistent with mental health-focused conceptions of recovery than those traditionally used within the substance abuse field, and they help demonstrate how recovery can be influenced by the organization of services in which consumers are embedded

Understanding the Critical Ingredients for Facilitating Consumer Change in Housing First Programming: A Case Study Approach

Housing First is a form of permanent supportive housing for chronically homeless consumers with mental health and substance abuse issues. In light of the model’s growing popularity and wide diffusion, researchers and policy makers have identified a need to better understand its critical ingredients and the processes through which they affect consumer outcomes. Researchers used a bottom-up approach to understand the critical ingredients of Housing First within community-based programs. Interviews and focus groups were conducted with 60 informants (staff and consumers) across 4 “successful” Housing First programs. Qualitative analysis demonstrated six program ingredients to be essential: (1) a low-threshold admissions policy, (2) harm reduction, (3) eviction prevention, (4) reduced service requirements, (5) separation of housing and services, and (6) consumer education

Evaluation of Indiana Access to Recovery

poster abstractThis presentation will discuss the evaluation of Indiana’s Access to Recovery (ATR) program. ATR is a 4-year federal demonstration grant managed by Indiana’s Division of Mental Health and Addiction (DMHA). ATR provides clients with access to services that are considered necessary components of recovery, but are often not available under traditional funding schemes (e.g., transportation, food access, housing). The evaluation started in May of 2012, and it is being carried out in collaboration with DMHA with funding from the Solution Center. Undergraduate and graduate student evaluators from the Center for Health Policy (CHP) are carrying out their work under the supervision of a faculty mentor. To date these students have: completed a literature review to assist DMHA in understanding ways to incentivize the work being carried out by providers; carried out 6 client focus groups and 15 provider phone interviews for formative evaluation purposes; and developed a logic model of the program. Students have also provided ongoing feedback to DMHA through their attendance at regularly scheduled advisory board meetings. Students are currently in the process of analyzing a large administrative database to provide feedback related to the effectiveness of the program. These finding will be of great benefit to DMHA as they seek to secure additional funding for ATR after the initial demonstration comes to a close. The presentation will discuss some of the early findings of the evaluation and a number of the lessons that students have learned about working in collaboration with a government partner

Negotiating the Boundaries of Mental Health and Illness: A Study of Recovery in Permanent Supportive Housing

Current sociological understandings of the effect that mental health services on consumers\u27 daily lives are still heavily informed by research conducted during the era of institutional treatment. This is problematic considering that changes to mental health care have shifted the locus of treatment to community settings for the majority of those living with serious and persistent mental illness (SPMI). With this shift there has been a greater focus on consumer-centered recovery in mental health care. The current study addresses this gap in the research by studying the recovery process for formerly chronically homeless individuals with dually diagnosed serious and persistent mental illness (SPMI) and substance use disorder who are living Housing First programming. Housing First is a model of permanent housing with supportive services that has been demonstrated to produce positive outcomes for hard-to-serve dually diagnosed consumers. I employed a combined case study and grounded theory approach that involved the collection and analysis of administrative, consumer, and staff data at four Housing First organizations in a large Midwestern city. My findings demonstrate that the recovery process in the programs was a negotiation between mental health and illness that consumers engaged in order to attain the highest quality of life possible in spite of symptoms related to their diagnosis. The structure of mental health services is key to this process, as it is more often than not the policies that guide programming that determine access to the resources that are necessary for consumers to engage in this negotiation

A CD-ROM Based Agricultural Information Retrieval System

An information retrieval system for agricultural extension was developed using CD-ROM technology as the primary medium for information delivery. Object-oriented database techniques were used to organize the information. Conventional retrieval techniques including hypertext, fulltext searching, and relational databases, and decision support programs such as expert systems were integrated into a complete package for accessing information stored on the CDROM. A multimedia user interface was developed to provide a variety of capabilities including computer graphics and high-resolution digitized images. Information for the disk was gathered and entered using extension publications which were tagged using an SGML-based document markup language. The fully operational CD-ROM system has been implemented in all 67 county extension offices in Flori

Predictors of Homeless Services Re-Entry within a Sample of Adults Receiving Homeless Prevention and Rapid Re-Housing Program (HPRP) Assistance

Local and national evaluations of the federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) have demonstrated a high rate of placement of program participants in permanent housing. However, there is a paucity of research on the long-term outcomes of HPRP, and research on rehousing and prevention interventions for single adults experiencing homelessness is particularly limited. Using Homeless Management Information System data from 2009 to 2015, this study examined risk of return to homeless services among 370 permanently housed and 71 nonpermanently housed single adult HPRP participants in Indianapolis, Indiana. Kaplan-Meier survival curves were conducted to analyze time-to-service re-entry for the full sample, and the homelessness prevention and rapid rehousing participants separately. With an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period. Overall, veterans, individuals receiving rapid rehousing services, and those whose income did not increase during HPRP had significantly greater risk of returning to homeless services. Veterans were at significantly greater risk of re-entry when prevention and rehousing were examined separately. Findings suggest a need for future controlled studies of prevention and rehousing interventions for single adults, aiming to identify unique service needs among veterans and those currently experiencing homelessness in need of rehousing to inform program refinement

Evaluating a Computer Program with a Structured Expert Review Process

A structured expert review process was implemented to evaluate the technical content and usability of a program on aeration system design for grain storages. Technical evaluation was used to determine if the computer program generated solutions similar to expert solutions. Other aspects of the evaluation focused on measures of ease of use, effectiveness of information conveyance and usefulness of solution. The evaluation procedure and questionnaires are described and results from the evaluation of an aeration system design program are summarized. The evaluation process served to validate the aeration system design program, generate suggestions for improving the program, identify areas for further research and advance aeration system design technology by bringing together experts representing the range of practice. The review process was beneficial and could be adapted for use with other decision support programs

Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment

Urban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, conducting workshops on cutting-edge developments in urban health, and bridging campus and community efforts in public health, including the Reconnecting to Our Waterways (RWO) initiative

Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review

Background: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the “black” category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. Methods: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. Conclusion: Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S