ORIGINAL PAPER Qualitative Research for and in Practice: Findings from Studies with Homeless Adults Who Have Serious Mental Illness and Co-Occurring Substance Abuse Deborah K. Padgett • Benjamin F. Henwood Published online: 22 June 2011 Ó Springer Science+Business Media, LLC 2011 Abstract This article draws upon findings from the New York Services Study, a Federally-funded qualitative study conducted in practice settings representing two funda- mentally different approaches to serving homeless adults with serious mental illness and co-occurring substance abuse. The findings yielded four themes—cumulative adversity, individual acts of kindness in a system designed to control, discordant case managers’ perspectives, and the benefits of permanent housing. Recommendations for practice include respecting individuality, being sensitive to previous traumas, and working to achieve housing security sooner rather than later. Future research is needed to study the micro-level contexts of service delivery and how they inhibit or encourage engagement in care. Keywords Homeless Á Serious mental illness Á Practice research In this article, we describe how the New York Services Study (NYSS)–funded by the National Institute of Mental Health from 2004 to 2008–produced findings that inform practice with homeless adults with serious mental illness. The NYSS, using qualitative methods, was devoted to understanding engagement and retention in care of home- less men and women with DSM Axis I disorders (schizo- phrenia, bipolar disorder, etc.) and histories of substance abuse. Their journeys into (and sometimes abruptly out of) residential service programs in New York City were the study’s focus with a comparison of ‘housing first’ and ‘treatment first’ programs constituting a primary goal. Given their status as one of the hardest-to-reach of cli- ents assisted by social workers, formerly homeless persons with serious mental illness were treated as the ‘experts’ and invited to share their stories in their own words. This represented a distinct departure from the vast literature in the field written from a provider’s, policymaker’s or researcher’s point of view. By also interviewing case managers, the NYSS sought to add another facet to understanding how mental health and other services are delivered in real-world settings. Background to the Study The NYSS was designed to examine two strikingly dif- ferent approaches to service delivery for homeless adults with serious mental illness. The first and newest of these, known as ‘housing first’ (HF) began with the formation of Pathways to Housing, Inc. in New York City in 1992. HF provides immediate access to one’s own apartment along with around-the-clock access to assertive community treatment (ACT) case management services. In keeping with a harm reduction philosophy, HF clients are not required to be clean and sober to retain their housing. When HF was put into practice, the vast landscape of homeless services designed to serve adults with serious mental illness consisted entirely of the ‘treatment first’ (TF) variety. ‘Treatment first’ (TF) programs require sobriety (via detox and periodic urine testing) and dormi- tory-style living with rules governing attendance at treatment programs, curfews, and limited or no visitors. Non-adherence to these rules can lead to discharge and/or D. K. Padgett (&) Á B. F. Henwood (&) Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA e-mail: dkp1@nyu.edu B. F. Henwood e-mail: bfh205@nyu.edu 123 Clin Soc Work J (2012) 40:187–193 DOI 10.1007/s10615-011-0354-1