Dennis P. Watson

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.

The Evolving Understanding of Recovery: What the Sociology of Mental Health has to Offer.

The meaning of recovery from serious mental illness (SMI) has evolved over time. Whereas it was not even considered to be a primary goal of treatment 30 years ago, it is the main focus of mental health policy today. These changes are partially the result of sociological research conducted during the age of institutional treatment and the early stages of community-based care. Despite these early influences, the sociology of mental health has largely overlooked the explicit study of recovery. This is because sociologists began shifting their focus from the study of SMI to the study of less severe mental health problems beginning in 1970s. In this article, I (a) discuss the evolving history of mental health recovery; (b) discuss how recovery is defined today in policy, practice, and research; and (c) present an argument for why sociological perspectives and methods can help shed light on the tensions between the definitions while assisting to develop better understandings of the recovery process. In this argument, I place particular attention on qualitative social psychological perspectives and methods because they hold the most potential for addressing some of the central concerns in the area of recovery research.

Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study

BackgroundThere is currently a lack of scientifically designed and tested implementation strategies. Such strategies are particularly important for highly complex interventions that require coordination between multiple parts to be successful. This paper presents a protocol for the development and testing of an implementation strategy for a complex intervention known as the Housing First model (HFM). Housing First is an evidence-based practice for chronically homeless individuals demonstrated to significantly improve a number of outcomes.Methods/designDrawing on practices demonstrated to be useful in implementation and e-learning theory, our team is currently adapting a face-to-face implementation strategy so that it can be delivered over a distance. Research activities will be divided between Chicago and Central Indiana, two areas with significantly different barriers to HFM implementation. Ten housing providers (five from Chicago and five from Indiana) will be recruited to conduct an alpha test of each of four e-learning modules as they are developed. Providers will be requested to keep a detailed log of their experience completing the modules and participate in one of two focus groups. After refining the modules based on alpha test results, we will test the strategy among a sample of four housing organizations (two from Chicago and two from Indiana). We will collect and analyze both qualitative and quantitative data from administration and staff. Measures of interest include causal factors affecting implementation, training outcomes, and implementation outcomes.DiscussionThis project is an important first step in the development of an evidence-based implementation strategy to increase scalability and impact of the HFM. The project also has strong potential to increase limited scientific knowledge regarding implementation strategies in general.

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.

Access to Recovery and Recidivism Among Former Prison Inmates

Access to Recovery (ATR) is a Substance Abuse and Mental Health Services Administration (SAMHSA)–funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. One of ATR’s goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state’s ATR program who returned to the community after incarceration. Results suggest that there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.

Everything Old Is New Again: Recovery and Serious Mental Illness

In this paper, we examine the emergence of recovery as an organizing construct within the mental health system and consider how it is changing mental health policy and practice, particularly as it relates to the treatment of people with “serious mental illness.” Recovery is most simply understood as the belief that people with mental health problems can “get better.” While this general idea is not new, it is currently a contested construct within the mental health field. We highlight several competing definitions of recovery and examine how these ideas have been incorporated into contemporary treatment modalities. We conclude with a discussion of how sociologists can contribute to a better understanding of the sociological dimensions of recovery and how a “sociology of recovery” might contribute to a more comprehensive and robust sociology of mental health and illness.

Alpha test results for a Housing First eLearning strategy: the value of multiple qualitative methods for intervention design

BackgroundDetailed descriptions of implementation strategies are lacking, and there is a corresponding dearth of information regarding methods employed in implementation strategy development. This paper describes methods and findings related to the alpha testing of eLearning modules developed as part of the Housing First Technical Assistance and Training (HFTAT) program’s development. Alpha testing is an approach for improving the quality of a product prior to beta (i.e., real world) testing with potential applications for intervention development.MethodsTen participants in two cities tested the modules. We collected data through (1) a structured log where participants were asked to record their experiences as they worked through the modules; (2) a brief online questionnaire delivered at the end of each module; and (3) focus groups.ResultsThe alpha test provided useful data related to the acceptability and feasibility of eLearning as an implementation strategy, as well as identifying a number of technical issues and bugs. Each of the qualitative methods used provided unique and valuable information. In particular, logs were the most useful for identifying technical issues, and focus groups provided high quality data regarding how the intervention could best be used as an implementation strategy.ConclusionsAlpha testing was a valuable step in intervention development, providing us an understanding of issues that would have been more difficult to address at a later stage of the study. As a result, we were able to improve the modules prior to pilot testing of the entire HFTAT. Researchers wishing to alpha test interventions prior to piloting should balance the unique benefits of different data collection approaches with the need to minimize burdens for themselves and participants.

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison

BackgroundIn response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called “pain clinics.” Whether a clinic falls into a state’s pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature.MethodsWe conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy.ResultsIn the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions.ConclusionsThis is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

Reliability and validity of the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) in real-world implementation

ABSTRACT This study examined the reliability and validity of the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT), a widely-used assessment of the health and social vulnerabilities and housing needs of individuals experiencing homelessness. Homeless Management Information System data were obtained for 1495 individuals who were administered the VI-SPDAT between 2014 and 2016. Subsamples were selected for reliability and validity assessments. Results suggest there are challenges to the reliability and validity of the VI-SPDAT in practical use. VI-SPDAT total scores did not significantly predict risk of return to homeless services, while type of housing was a significant predictor. Vulnerability assessment instruments have important implications for communities working to end homelessness by facilitating prioritization of scarce housing resources. Findings suggest that further testing and development of the VI-SPDAT is necessary.

Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011–2016

Objectives To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths. Methods We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings. Results Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%. Conclusions Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. Public Health Implications Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.