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Why Use Mixed Methods?Content and Presentation by

Russell K. Schutt

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Before we get started…

Let’s

take a moment to answer 2 quick questions

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Dr. Russell K.

Schutt

University of Massachusetts, Boston

Erica DeLuca

Executive Marketing Manager, SAGE

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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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Russell K. Schutt

, Ph.D.University of Massachusetts Boston

Why Use Mixed Methods?

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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

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

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Outline

1. The Research Question2. Mixed Methods3. Findings a. Consumer and clinician preferences b. Housing type c. Social processes d. Interaction effects

4. Conclusions

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The Research Question

1. Originality2. Complexity3. Ambiguity4. Authenticity

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Hypotheses & QuestionClient 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?

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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

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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

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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)

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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)

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Mixed Methods

a. Design type b. Measurement c. Case selection d. Experimental design e. Process analysis f. Contextual analysis

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Mixed Method Designs

  Priority

  

 

Prioritized

Equal

 

 

Sequencing

Sequential

Staged Method

Qual



QUAN

Quan



QUAL

QUAL



quan

QUAN



qual

Research Program

QUAL



QUAN

QUAN



QUAL

 

Concurrent

Embedded Method

QUAL(quan)

QUAN(qual)

Integrated Method

QUAL+QUAN

Schutt 2015: 545

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Measurement:

Preferences & RecommendationsPreferences

(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

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Case Selection: The Sample

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Research (Experimental) Design

Group

GroupApt.

Group

Apt.

Baseline 6 Mos. 12 Mos. 18 Mos.

R

PSC

PSW

BVI

DMH

Shelters

Screening

Apt.

3 yrs,

20 yrs.

Neuropsych

testing Ethnographic Observation

Neuropsych

Clinician Recommendation, comments Life Skills Profiles

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Process Analysis: Evolution

Staff

Resident

Group

Traditional

Group

Consumer-Run

Single

Supported Living

Independent Apartments

Control

Tenants

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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

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Findings

1. Consumer & Clinician Preferences2. Housing type3. Social processes4. Interaction effects

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Consumer preferences,clinician recommendations

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Clinician Recommendations, Consumer Residential Preferences

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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”

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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 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.

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Housing type(CAUSAL EFFECT)

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Any Homelessness by Housing Type &

Followup

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SOCIAL PROCESSES(MECHANISM)

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Encouraging Social Ties

Staff engagementplanned outingsexpressive art activities; basement recreation centersimple birthday celebrations ; Thanksgiving dinner

modeling behaviorTenant activitiesgroup shopping trips, group meals, chore days talking and laughing together; partiesMeetings divergent opinions

; friendly

and supportive.

shared

responsibilities; voting for new

staff member

planning group meals and shopping

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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...”

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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

.

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Anti-Social Experiences

Substance abusetension and emotional outbursts in meetingstheft to support drug use; dealers in housePsychiatric symptomsexpressions of bizarre ideasloud, abrupt, screaming in your face Reactions to staffcomplaints about staff “telling me when to play the stereo and how loud”

Disputes over medication, rep payee status, guestsInterpersonal tensionrudeness; harassing women, incessant swearingloud music; TV control; not contributing to house kitty

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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.”

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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 a

sked

to leave.

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Interaction effects (CONTEXT)

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% Days Homeless by Substance Abuse, Race,

& Housing Type Minority White

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% Days Homeless by Housing Type & Preference/Rec.

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Change in Executive Functioning by Housing & Clinician Recommendation

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Change in Executive Functioning by Housing & Substance Abuse

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Conclusions

Substantive conclusionsMethodological lessons

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Substantive Conclusions

Group Housing Maximizes Housing Retention, CognitionConsumer Preferences Do Not Predict Optimal PlacementClinicians Can Predict Need for Support Rejection of Needed Support Predicts Housing LossSocial Interaction Helps Some Regain StabilityRejection of Needed Support and Substance Abuse Interfere with Cognitive Benefits from Social Process

Individual Orientations May Challenge Social Process

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Methodological Lessons

Research questions must correspond in complexity to the social worldResearch vision constrained by limited methods Mixed methods transform and enrich understanding of measures & causal processInteractions reveal context with mixed methodsMixing methods can be an iterative process, in design or analysis, thus allowing exploration and confirmation of emerging patternsMixed methods improve authenticity and theory

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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 StaffBrina Caplan**,

EdD, PhD; Win Turner, PhD, George Tolomiczenko, PhD; Mark Abelman, MSWFundingNational Institute of Mental Health, HUD

*UMass Boston

**NARSAD

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Blog

Investigatingthesocialworld.com

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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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Webinar recording available on

www.sagepub.com/sagetalks.

Why Use Mixed Methods?

Be

sure to

check our website for updates on our 2015 Spring webinar series!