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Los Angeles | London | New Delhi Singapore | Washington DC Why Use Mixed Methods? Content and Presentation by Russell K. Schutt
Los Angeles | London | New Delhi Singapore | Washington DC Dr. David Fetterman November 20 2014 #SAGEtalks Before we get started… Let’s take a moment to answer 2 quick questions
Los Angeles | London | New Delhi Singapore | Washington DC Dr. David Fetterman November 20 2014 #SAGEtalks Dr. Russell K. Schutt University of Massachusetts, Boston Erica DeLuca Executive Marketing Manager, SAGE
Los Angeles | London | New Delhi Singapore | Washington DC Dr. David Fetterman November 20 2014 #SAGEtalks While we do our best to answer as many questions as we can, time constraints may not allow us to answer every question. Thank you for understanding. Send us your questions! Using Twitter? Use the hashtag #SAGEtalks. Send in your questions via the Chat Box on your screen. →
Russell K. Schutt, Ph.D. University of Massachusetts Boston Why Use Mixed Methods?
The home of Mr. and Mrs. Henry Adams Breckenridge…three stories topped by a captain’s walk…. Large trees and a tall thick hedge…garden stretches one hundred yards…many old rose bushes. …The life and surroundings, old-family and upper-upper,… Her [I.S.C.] ratings give her a final score of 12, or perfect…. (Warner 1960. Social Class in America.) Long exploratory interviews with key informants, …the actual political life of the union, attending union meetings…. … At this point it seemed that crucial aspects of the internal political process could best be studied through survey research methods, 500 interviews …. (Lipset, Trow, Coleman 1956. Union Democacy.) Such complexity and interdependency requires agile research strategies …assess causal factors at multiple levels, flexibly incorporate new information as it arises. Enabling creative and productive conversation: qualitative, quantitative measurement; analytic modalities. (Brown 2013) Mixed Methods Past & Present
Outline 1. The Research Question 2. Mixed Methods 3. Findings a. Consumer and clinician preferences b. Housing type c. Social processes d. Interaction effects 4. Conclusions
The Research Question 1. Originality 2. Complexity 3. Ambiguity 4. Authenticity
Hypotheses & Question Client outcomes will be more favorable in group than in independent housing. Client outcomes will be more favorable if client and clinician housing choice match. By what process do group homes evolve to consumer-operated households?
GROUP HOME: A traditional community residence for a group of individuals with chronic mental illness. 24 hour supervision with awake overnight staff. INDEPENDENT APARTMENT: A supported housing program serving individuals who require mental health and community services. Originality: Housing Comparison
Social integration protective for suicide (Durkheim). Loneliness: depressive symptoms, chronic health conditions, elevated blood pressure, stress, helplessness, social problems (Cacioppo & Patrick 2008) Social stimulation & neurogenesis ( Kempermann, Brandon & Gage 1998) Social interaction & rehabilitation (Kern et al. 2009) 67% - 90% homeless singles choose living alone (Neubauer 1993; Owen et al., 1996; Tanzman 1993).
Practicality: Policy Relevance Consumer preference is a key theme of Council innovations. (Interagency Council, Homeless 2008) Housing First: “Service plans are not based on clinician assessments of consumers’ needs but driven by consumers’ own treatment goals.” (Tsemberis 2010) Mainstream housing where persons live alone and manage in their own apartments by themselves is beyond the capability of the great majority. (Lamb, 1990)
Authenticity: A Mechanism 6-25% lose independent housing within one year. Up to 50% lose housing after five years. Very intensive services lower the 5-year risk to 25%. Long-term housing loss higher for dually diagnosed. No clear advantage of a specific housing type. (Kasprow et al., 2000; Kertesz et al. 2009; Leff et al. 2009; Lipton et al., 2000; Lipton, Nutt and Sabitini, 1988:43; O’Connell et al. 2008; Padgett, Gulcur and Tsemberis, 2006; Shern et al., 1997; Siegel et al. 2006; Stefanic and Tsemberis 2007)
Mixed Methods a. Design type a. Design type b. Measurement c. Case selection d. Experimental design e. Process analysis f. Contextual analysis
Mixed Method Designs Priority PrioritizedEqual Sequencing Sequential Staged Method Qual QUAN Quan QUAL QUAL quan QUAN qual Research Program QUAL QUAN QUAN QUAL ConcurrentEmbedded Method QUAL(quan) QUAN(qual) Integrated Method QUAL+QUAN Schutt 2015: 545
Preferences (α =.72) If you now had a choice of living with others in a shared residence or alone in your own apartment, which would you prefer? 1 = Group living 2 = Apartment a. How strongly? How would you feel about having staff come in just during the day and help with cooking, cleaning and shopping? (1-5) Ethnographic Observation; Clinician observations Recommendations (α =.84) Overall, taking into account all of your sources of information, do you believe that this person will do better clinically living in an evolving consumer household or in an IL? (1-5) Clinician comments (inter-rater r =.66 -.91) Behavioral risk; Needs support,Needs structure); Social withdrawal); Poor insight; Substance abuse
Research (Experimental) Design Group Apt. Group Apt. Baseline 6 Mos. 12 Mos. 18 Mos. PSC PSW BVI DMH Shelters Screening Apt. 3 yrs, 20 yrs. Neuropsych testing Ethnographic Observation Neuropsych Clinician Recommendation, comments Life Skills Profiles
Process Analysis: Evolution StaffResident GroupTraditionalGroup Consumer- Run Single Supported Living Independent Apartments Control Tenants
Measures of Context MeasureDescriptionBaseline Value Lifetime Substance Abuse (38) SCID-based, scored as no use, some use, abuse or dependence 61.3% abuse or dependence Clinician Housing Recommendation (39) Average of answers to nine questions by two independent raters, scored 1-5 Mean=3.18, s.d.=.46. Cronbach’s alpha =.84
Findings 1. Consumer & Clinician Preferences 2. Housing type 3. Social processes 4. Interaction effects
Consumer Preferences by Clinician Recommendations “Ability to organize thoughts good; can successfully live either setting; history of independence.” “Inability to manage money, no insight; anger, hostility, limited skills; polysubstance abuse; high risk”
Clinicians Recommended Independent Living Clinicians Recommended Independent Living Participates in meetings, school, active outside of house; No meds, self-medicating; Got own apartment; High functioning; Sociable, active, talkative; Motivated. Clinicians Recommended Group Living Low self-esteem, paranoid; Drug abuse, in and out of detox; Isolated, angry, alcoholic, antisocial, abusive; Cocaine use in house (so expelled); Difficult, into pornography and drugs.
Staff engagement planned outings planned outings expressive art activities; basement recreation center expressive art activities; basement recreation center simple birthday celebrations ; Thanksgiving dinner simple birthday celebrations ; Thanksgiving dinner modeling behavior modeling behavior Tenant activities group shopping trips, group meals, chore days group shopping trips, group meals, chore days talking and laughing together; parties talking and laughing together; parties Meetings divergent opinions ; friendly and supportive. divergent opinions ; friendly and supportive. shared responsibilities; voting for new staff member shared responsibilities; voting for new staff member planning group meals and shopping planning group meals and shopping
“Things have really come together, … we're working together as a group more.” “Do you know how much help I asked for today [making dinner]? I never did that before!” “People are really hanging out together— talking, helping each other out.” “People still grumble, but things get resolved now. I've even heard people apologize...”
A Case Study of Improvement She did not seem to have close relations to anyone in the house, just sitting in a chair…didn’t get out of the house, apprehensive toward doing things independently. She attended all meetings but rarely participated. High functioning in self- care. After a while, started to become slightly more involved, cooked a group meal, participated in a homelessness demo. She engaged in weekly outings with female staff and residents. Then she became more social, joking more frequently and participating more in meetings. Finally she was more independent outside the house and felt comfortable reducing house staff.
Anti-Social Experiences Substance abuse tension and emotional outbursts in meetings tension and emotional outbursts in meetings theft to support drug use; dealers in house theft to support drug use; dealers in house Psychiatric symptoms expressions of bizarre ideas expressions of bizarre ideas loud, abrupt, screaming in your face loud, abrupt, screaming in your face Reactions to staff complaints about staff “telling me when to play the stereo and how loud” complaints about staff “telling me when to play the stereo and how loud” Disputes over medication, rep payee status, guests Disputes over medication, rep payee status, guests Interpersonal tension rudeness; harassing women, incessant swearing rudeness; harassing women, incessant swearing loud music; TV control; not contributing to house kitty loud music; TV control; not contributing to house kitty
Negative Social Experiences “She finds it difficult to know when someone is going to lose their temper with her all of a sudden.” “These people just don't know how to have normal human relations.”
A Case Study of Deterioration The resident was causing conflict…tenants complaining she didn’t do her share of housework, played loud music late at night, drank in the house, and got into lots of arguments. She missed many meetings and got defensive when people brought up disruptive things she does, but other tenants were afraid to confront her. She did not respond to a staff “ultimatum” or to a tenant letter asking her to change and blamed her problems on her traumatized past. Conflict continued over her drinking and enforcing house rules. Finally, she was asked to leave.
Substantive Conclusions Group Housing Maximizes Housing Retention, Cognition Consumer Preferences Do Not Predict Optimal Placement Clinicians Can Predict Need for Support Rejection of Needed Support Predicts Housing Loss Social Interaction Helps Some Regain Stability Rejection of Needed Support and Substance Abuse Interfere with Cognitive Benefits from Social Process Individual Orientations May Challenge Social Process
Methodological Lessons Research questions must correspond in complexity to the social world Research vision constrained by limited methods Mixed methods transform and enrich understanding of measures & causal process Interactions reveal context with mixed methods Mixing methods can be an iterative process, in design or analysis, thus allowing exploration and confirmation of emerging patterns Mixed methods improve authenticity and theory
Boston McKinney Project Investigators Stephen M. Goldfinger, MD (PI); Russell K. Schutt*, PhD; Larry J. Seidman, PhD; Barbara Dickey, PhD; Walter E. Penk, PhD; Norma Ware, PhD; Sondra Hellman, RN, MS, Martha O’Bryan, RN Research Staff Brina Caplan**, EdD, PhD; Win Turner, PhD, George Tolomiczenko, PhD; Mark Abelman, MSW Funding National Institute of Mental Health, HUD *UMass Boston **NARSAD
Los Angeles | London | New Delhi Singapore | Washington DC Michael Quinn Patton December 2014 #SAGEtalks While we do our best to answer as many questions as we can, time constraints may not allow us to answer every question. Thank you for understanding. Send us your questions! Using Twitter? Use the hashtag #SAGEtalks. Send in your questions via the Chat Box on your screen. →
Los Angeles | London | New Delhi Singapore | Washington DC Michael Quinn Patton December 2014 #SAGEtalks Webinar recording available on www.sagepub.com/sagetalks. www.sagepub.com/sagetalks Why Use Mixed Methods? Russell K. Schutt Blog Website Be sure to check our website for updates on our 2015 Spring webinar series!
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