Los Angeles | London | New Delhi Singapore | Washington DC Dr. David Fetterman November 20 2014 #SAGEtalks Please be sure to check your settings Make sure

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Dr. David FettermanNovember 20 2014 #SAGEtalks

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Why Use Mixed Methods?

Content and Presentation byRussell K. Schutt



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Dr. Russell K. SchuttUniversity of Massachusetts,

Boston

Erica DeLucaExecutive Marketing Manager, SAGE



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Russell K. Schutt, Ph.D.University of Massachusetts Boston


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

http://www.hup.harvard.edu/

Outline

1. The Research Question2. Mixed Methods3. Findings

a. Consumer and clinician preferencesb. Housing typec. Social processesd. Interaction effects

4. Conclusions

The Research Question

1. Originality2. Complexity

3. Ambiguity4. 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).

Complexity: Social Needs v. Preferences

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 Mechanism6-25% 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 typeb. Measurementc. Case selectiond. Experimental designe. Process analysisf. Contextual analysis

Mixed Method Designs Priority Prioritized Equal

Sequencing

Sequential Staged Method

QualQUAN

QuanQUAL

QUALquan

QUANqual

Research Program

QUALQUAN

QUANQUAL

Concurrent Embedded Method

QUAL(quan)

QUAN(qual)

Integrated Method

QUAL+QUAN

Schutt 2015: 545

Measurement: Preferences & Recommendations

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

Case Selection: The Sample

Male Age

Vetera

n

Min

ority

HS Gra

d

PT Wor

k

PsyHos

p

Schizp

SubsAb

0102030405060708090

100

Research (Experimental) Design

Group Group

Apt.

Group

Apt.

Baseline 6 Mos. 12 Mos. 18 Mos.

PSC

PSW

BVI

DMHShelters

Screeni

ng

Apt.

3 yrs,20 yrs.

Neuropsych testing Ethnographic Observation Neuropsych

Clinician Recommendation, comments Life Skills Profiles

Process Analysis: Evolution

Staff Resident

Group Traditional

Group

Consumer-Run

Single Supported Living

Independent

Apartments

ControlTe

nant

s

Measures of Context

Measure Description Baseline 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 Preferences2. Housing type3. Social processes4. Interaction effects

CONSUMER PREFERENCES,CLINICIAN RECOMMENDATIONS

Clinician Recommendations, Consumer Residential Preferences

FT Staff Indep Apt0

10

20

30

40

50

60

70

80

90

100

Clinician AClinician BConsumers

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”

Observed Behavior (extreme cases)

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 LivingLow 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.

HOUSING TYPE(CAUSAL EFFECT)

McKinney 18 Mos.

McK in Metro DB

Metro DB McK & Metro

0

10

20

30

40

50

60

70

Group

Indep

Any Homelessness by Housing Type & Followup

SOCIAL PROCESSES(MECHANISM)

Encouraging Social Ties Staff engagement

planned outings expressive art activities; basement recreation center simple birthday celebrations ; Thanksgiving dinner modeling behavior

Tenant activities group shopping trips, group meals, chore days talking and laughing together; parties

Meetings divergent opinions ; friendly and supportive. shared responsibilities; voting for new staff member planning group meals and shopping

Community Feeling

“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 ImprovementShe 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 theft to support drug use; dealers in house

Psychiatric symptoms expressions of bizarre ideas loud, abrupt, screaming in your face

Reactions to staff complaints about staff “telling me when to play the

stereo and how loud” Disputes over medication, rep payee status, guests

Interpersonal tension rudeness; harassing women, incessant swearing 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.

INTERACTION EFFECTS (CONTEXT)

% Days Homeless by Substance Abuse, Race, & Housing Type

None Some Abuse None Some Abuse0

10

20

30

40

50

60

70

80

Group

Indep

Minority White

% Days Homeless by Housing Type & Preference/Rec.

Both Prefer Apartment

Consumers Prefer Apt,

Clinicians Say Group

Consumers Prefer Group, Clinicians Say

Apt

Both Prefer Group

0

5

10

15

20

25

30

35

GroupIndep

Change in Executive Functioning by Housing & Clinician Recommendation

Rec=Group Rec=Indep

-0.5

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

0.4

0.5

GroupIndep

Change in Executive Functioning by Housing & Substance Abuse

Time 1 Time 2 Time 30

0.5

1

1.5

2

2.5

3

3.5

4

ECH-NoSubs

IL-NoSubs

ECH-Subs

IL-Subs

Conclusions

Substantive conclusions

Methodological lessons

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 ProjectInvestigators 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 StaffBrina Caplan**, EdD, PhD; Win Turner, PhD, George Tolomiczenko, PhD; Mark Abelman, MSW

FundingNational Institute of Mental Health, HUD*UMass Boston**NARSAD

BlogInvestigatingthesocialworld.com


Michael Quinn PattonDecember 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.

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Michael Quinn PattonDecember 2014 #SAGEtalks

Webinar recording available on www.sagepub.com/sagetalks.


Russell K. Schutt

• Blog• Website

Be sure to check our website for updates on our 2015 Spring webinar series!

http://www.sagepub.com/sagetalks

http://investigatingthesocialworld.com/

http://rschutt.wikispaces.umb.edu/

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Los Angeles | London | New Delhi Singapore | Washington DC Dr. David Fetterman November 20 2014 #SAGEtalks Please be sure to check your settings Make sure