Social networks of the recovering homeless associations with health and wellbeing

Transcription

1 Social networks of the recovering homeless associations with health and wellbeing Lynne C. Messer, PI Stephanie Farquhar, Ted Amann, Central City Concern

2 Significance! Social support is important for health and wellbeing and is linked to behavior, including mental health and addictions! Peers, both formal (paid) and informal, are an important source of social support! The type of support provided by peers is important and may vary by stage of recovery! The peer s position in the social network structure may be important for understanding their influence on health and wellbeing, but limited research has been undertaken among recovering adults

3 More significance! Social networks, including peers, are important influences on employment, education and sexual risk! One promise of network analysis is the potential for network modifiability! The proposed work is situated in a communitybased participatory research (CBPR) framework, which builds capacity and project ownership while simultaneously increasing the likelihood that research results will be meaningful and incorporated into practice

4 Conceptual framework Social-structure conditions (macro-level) Social networks (mezzo-level)! Psychosocial and material mechanisms (micro-level) Outcomes CULTURE Norms, values Racism, sexism SOCIO- ECONOMIC FACTORS Poverty Discrimination POLITICS Legal system Differential participation SOCIAL CHANGE Urbanization HIV PREVALENCE NETWORK STRUCTURE Size Density Proximity Homogeneity Reachability TIE ATTRIBUTES Frequency Stability Duration Intimacy Exposure Support provided SOCIAL SUPPORT Instrumental Informational Appraisal Emotional SOCIAL ENGAGEMENT Reinforcement of meaningful roles Interpersonal attachment Adult role prep SOCIAL INFLUENCE Help-seeking norm Peer pressure Constraining / enabling processes RESOURCE ACCESS Stable housing Employment opportunities Educational assistance Legal assistance Health care HEALTH BEHAVIORS Safe sex practices Proper health care usage Recovery adherence Treatment participation Diet, exercise Help-seeking WELL-BEING Housing stability Employment participation Education participation Crime abstinence PHYSICAL HEALTH Self-rated health HIV/other STIs MENTAL HEALTH Coping Depression Anxiety Yellow = testable network-health pathway; Green = testable network-employment pathway DRUG USE ABSTINENCE

5 Specific aims! Aim #1: Identify the structural role peers play in social support and how this role changes over time for consumers of CCC peerbased programs using social network methods.! Network data will be collected from individuals representing three stages of addiction recovery (early abstinence, maintenance, advanced recovery) at two separate times (baseline, 6-month follow-up).! The working hypothesis for Aim 1 is that the peer s network role varies by time and phase of recovery.! Aim #2: Examine how peers and the broader support network influences recovery and 6-month health (physical and mental), wellbeing (housing, employment, education, crime abstinence) and recovery outcomes using regression methods.! The working hypothesis for Aim 2 is that different network characteristics will be associated with better health and wellbeing outcomes among CCC consumers, adjusted for time and recovery phase.

6 Approach! Participants of two peer-based programs represent sampling frame! Sampled from 3 phases of recovery! Recruitment from weekly program meetings! Retention CCC has got this under control! Data collection trained Consumer Advisory Council members; surveyed at baseline and six months later! Protocol surveys on ipad?! Analysis UCINET, GLLAMM

7 Longitudinal study design Early recovery! Early recovery Maintenance Maintenance Advanced recovery Advanced recovery TIME 1 6 months TIME 2

8 Table 1. Network measures constructed from data collection Social networks ( alters refers to persons named by respondent in network survey) Network size, network Count of named network members (alters), count of density alters / possible number of alters Personal network Degree to which alters behave in a certain way (use exposure drugs) or have a certain attribute (are employed) Tie strength Count, frequency, and length of time spent in interactions with alters Network Estimate by respondent of who among named network interconnectedness members (alters) know each other Support provision Instrumental/material, informational, appraisal/advice, and emotional support Social influence Help-seeking norm modeling, peer pressure to remain in recovery, other topics of conversation Alter traits Sex/gender, age, employment status, education level, recovery status, etc. of named network members (alters)!! Table 2. Outcome measures constructed from data collection Well-being outcomes Housing stability Stably housed (yes/ no) Employment Employed or employment preparation (yes/no) Education participation In school or training program (yes/no) Abstinence from crime Criminal activity in past 30, 60, 90 days (yes/no) Physical health Self-rated health Excellent, very good, good, fair, poor (ordinal 1-5) HIV / STI diagnosis HIV diagnosis ever (yes/no) STI diagnosis in last 30, 60, 90 days (yes/no) Mental health Coping style Continuous scale (72-360); 8 scales, 4 subscales Depression Continuous scale (0-27); established ordinal cutpoints Anxiety Ordinal measure (1-3) Drug use abstinence Recovery participation Participating in recovery activities (yes/no) Abstinence Currently abstaining from drugs (yes/no)!! Network and outcome measures

9 Why is this research to action?! Because now we can actively wait (until reviewed in June or July 2014)! Because we will be actively involving consumers in the community-based participatory process! Because our findings, following the successful completion of the project, will inform treatment practices both locally and distally! Because this is the beginning of an active research program that can include others

10 Thank you.