Department of Health Policy and Management Works

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    ‘Clustering of exemptions’ as a collective action threat to herd immunity
    (2003-03) May, Thomas; Silverman, Ross D.
    In this paper, we examine the phenomenon of ‘clustering of exemptions’ to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can “self-select” in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.
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    Patient Safety and Patients' Rights
    (2004-06) Silverman, Ross D.
    Patient safety can be improved through the implementation of a physician reporting system, in which medical errors can be reported confidentially. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
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    From Structural Chaos to a Model of Consumer Support: Understanding the Roles of Structure and Agency in Mental Health Recovery for the Formerly Homeless
    (2012-07) Watson, Dennis P.
    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.
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    The Evolving Understanding of Recovery: What the Sociology of Mental Health has to Offer
    (2012-11) Watson, Dennis P.
    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.
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    Understanding the Critical Ingredients for Facilitating Consumer Change in Housing First Programming: A Case Study Approach
    (2013-04) Watson, Dennis P.; Wagner, Dana E.; Rivers, Michael
    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.
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    The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users
    (2013-05) Watson, Dennis P.; Orwat, John; Wagner, Dana E.; Shuman, Valery; Tolliver, Randi
    Background The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. Methods The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. Results The results provided evidence for the overall reliability and validity of the index. Conclusions The results demonstrate the index’s ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM.
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    Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study
    (BioMed Central, 2014) Watson, Dennis P.; Young, Jeani; Ahonen, Emily Q.; Xu, Huiping; Henderson, Macey; Shuman, Valery; Tolliver, Randi; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Background: There 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/design: Drawing 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. Discussion: This 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.
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    Developing a Model Curriculum for a University Course in Health Impact Assessment in the United States
    (Taylor & Francis, 2014-10-29) Pollack, Keshia M.; Dannenberg, Andrew L.; Botchwey, Nisha D.; Stone, Cynthia L.; Seto, Edmund
    As Health Impact Assessment (HIA) become increasingly common in the U.S. there is growing demand for instruction beyond sho1i courses and online training. As of October 2013, there are graduate level courses that include instruction on HIA in at least 17 universities in the U.S., including 4 courses that focus explicitly on HIA. Instructors of these four courses collaborated to develop a model curriculum for teaching HIA that draws on a framework for experiential learning and on a theoretical model of curriculum formulation. This article includes an in-depth analysis of these courses and presents a model curriculum for HIA instruction during an academic quaiier or semester course in a University. This model curriculum may help faculty develop a graduate level HIA course at their institution, as well as inform public health and community design professionals interested in building capacity to conduct HIAs, and students considering taking an HIA course. International instructors could also learn from the U.S. experience, and apply the model curriculum to their setting and educational structure.