The document summarizes a mixed methods study on housing outcomes for individuals with chronic mental illness. It compares outcomes for those living in group homes versus independent apartments. Data was collected through surveys, clinician assessments, ethnographic observation, and neuropsychological testing. Key findings include: (1) group housing was associated with better housing retention and cognition compared to independent living, especially for those with substance abuse issues or rejection of needed support; (2) consumer preferences did not predict optimal placement as clinicians could better assess need for support; (3) positive social processes in group homes helped some regain stability while negative experiences interfered with outcomes. The study demonstrates how mixed methods can provide a more authentic and nuanced understanding of social phenomena than a

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Why Use Mixed Methods?
Content and Presentation by
Russell K. Schutt

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Dr. David Fetterman
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Dr. David Fetterman
November 20 2014 #SAGEtalks
Dr. Russell K. Schutt
University of Massachusetts,
Boston
Erica DeLuca
Executive Marketing Manager, SAGE

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6. Russell K. Schutt, Ph.D.
University of Massachusetts Boston
Why Use Mixed
Methods?

8. 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

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

10. 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

11. The Research Question
1. Originality
2. Complexity
3. Ambiguity
4. Authenticity

12. 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?

13.  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

14.  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).

15. 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)

16. 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)

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

18. 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

19. 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

20. Case Selection: The Sample
0
20
40
60
80
100

21. Research (Experimental) Design
Group Group
Apt.
Group
Apt.
Baseline 6 Mos. 12 Mos. 18 Mos.
PSC
PSW
BVI
DMH
Shelters
Apt.
3 yrs,
20 yrs.
Neuropsych testing Ethnographic Observation Neuropsych
Clinician Recommendation, comments Life Skills Profiles

22. Process Analysis: Evolution
Staff Resident
Group Traditional
Group
Consumer-
Run
Single Supported
Living
Independent
Apartments
Control
Tenants

23. 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

24. Findings
1. Consumer & Clinician Preferences
2. Housing type
3. Social processes
4. Interaction effects

25. CONSUMER PREFERENCES,
CLINICIAN RECOMMENDATIONS

26. Clinician Recommendations,
Consumer Residential Preferences
0
10
20
30
40
50
60
70
80
90
100
FT Staff Indep Apt
Clinician A
Clinician B
Consumers

27. 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”

28. 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.

29. HOUSING TYPE
(CAUSAL EFFECT)

30. 0
10
20
30
40
50
60
70
McKinney 18
Mos.
McK in Metro
DB
Metro DB McK & Metro
Group
Indep
Any Homelessness by Housing
Type & Followup

31. SOCIAL PROCESSES
(MECHANISM)

32.  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

33.  “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...”

34. 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.

35. 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

36. 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.”

37. 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.

38. INTERACTION EFFECTS
(CONTEXT)

39. % Days Homeless by Substance
Abuse, Race, & Housing Type
0
10
20
30
40
50
60
70
80
None Some Abuse None Some Abuse
Group
Indep
Minority White

40. % Days Homeless by Housing
Type & Preference/Rec.
0
5
10
15
20
25
30
35
Both Prefer
Apartment
Consumers
Prefer Apt,
Clinicians Say
Group
Consumers
Prefer Group,
Clinicians Say
Apt
Both Prefer
Group
Group
Indep

41. Change in Executive Functioning by
Housing & Clinician Recommendation
-0.5
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
Rec=Group Rec=Indep
Group
Indep

42. Change in Executive Functioning
by Housing & Substance Abuse
0
0.5
1
1.5
2
2.5
3
3.5
4
Time 1 Time 2 Time 3
ECH-NoSubs
IL-NoSubs
ECH-Subs
IL-Subs

43. Conclusions
Substantive conclusions
Methodological lessons

44. 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

45. 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

46. 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

47. Blog
Investigatingthesocialworld.com

48. 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
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49. Los Angeles | London | New Delhi
Singapore | Washington DC
Michael Quinn Patton
December 2014 #SAGEtalks
Webinar recording available on www.sagepub.com/sagetalks.
Why Use Mixed Methods?
Russell K.
Schutt
• Blog
• Website
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