The ties that bind: Using ethnographic methods to understand service engagement

While rates of disengagement from mental health services remain high, the Housing First program has succeeded in engaging those who are hardest-to-reach, people who have experienced long-term homelessness and co-occurring disorders. This study uses ethnographic methods to explore service engagement within Housing First, focusing on how social processes contribute to program effectiveness. Conducting participant observation and interviews, researchers followed 10 clients and 14 case managers from two treatment teams, over the course of a year. The study used symbolic interactionism as its theoretical framework. In data analysis, therefore, the researchers explored meaning-making within social exchanges. The sites and activities of the program provided a context that made it possible for case managers and residents to create shared narratives about residents' experiences related to housing. The variation of these sites and activities led case managers to permeate many aspects of clients' lives, playing roles similar to those of friends and family. The quality of the interaction became apparent from how case managers paid attention, listened, and communicated while engaging in these shared activities. This study illustrates that while the structural aspects of Housing First provided the context and opportunities for engagement, the quality of the interaction between the case managers and residents played a key role in engagement.