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Integrated Health Care for African Americans with Serious Mental Illness Who Are Homeless in Chicago’s Edgewater-Uptown Neighborhood

This three-year project is funded by the National Institute on Minority Health and Health Disparities (NIMHD; Grant # R24MD007925) and was a response to the NIMHD Request for Applications, NIMHD Community-Based Participatory Research (CBPR) Initiative in Reducing and Eliminating Health Disparities: Planning Phase (R24)(RFA-MD-12-006).  The goal of this funding opportunity is to “ partnerships between health disparity communities and researchers to engage in community-based participatory research (CBPR) to plan and implement interventions to reduce health disparities." (NIMHD, 2012).  A copy of the funded proposal narrative can be accessed here.

This project aims to adopt a CBPR approach to develop an intervention to reduce health care disparities amongst a highly marginalized population in Chicago's Edgewater-Uptown neighborhoods: African Americans with serious mental illnesses who are homeless. Below is a list of the key project personnel responsible for this work and their corresponding roles and institutions:


Susan Pickett

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Advocates for Human Potential, Inc.


Ed Stellon

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Heartland Health Outreach


Dana Kraus

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Illinois Institute of Technology

Project Manager

Annie Schmidt

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Illinois Institute of Technology

Research Assistant




Project Summary

People who are homeless have a high incidence and prevalence of physical illness that are further exacerbated by co-occuring serious mental illnesses.  African Americans are disproportionately affected by homelessness with as many as 50% of homeless people being African American.  In Illinois, the homeless population is increasing and expected to rise 5%.  In Chicago from 2006-2010, shelter use rose from 28.4% and those unsheltered surged to 40.4%.  One neighborhood especially hard hit is the Edgewater-Uptown area with among the highest rate of homeless people with co-occuring mental illness in the country.  Although integrated care programs have been proposed and developed for this population, they have had limited impact in part because they have not fully incorporated the voice of the homeless in development and implementation.  Hence, we propose a community-based participatory research (CBPR) project meant to target the healthcare needs of African Americans who are homeless with serious mental illness.  A preliminary needs assessment with the group helped to direct this proposal.  We will establish a Community Research Team (CRT; referred to as the Community Advisory Board/CAB in the original proposal) comprised of African Americans with lived experience and co-chaired by the co-PIs including an African American with lived experience.  The CRT will have control over all aspects of the proposal.  To define the problem, we will conduct qualitative interviews of people with lived experience and other stakeholders and then cross-validate this information with a second group in a quantitative survey.  The CRT will use this information to design an intervention using an integrated care model.  Feasibility, acceptability, and impact of the intervention will then be tested in a pilot evaluation.  Outcomes will include assessments of perceived availability, program satisfaction, physical and mental health, and quality of life with a longitudinal design (baseline, midpoint, and follow-up).

Specific Aims

·     Establish a Community Research Team (CRT) co-chaired by this proposal’s PI (Corrigan) and co-PI, Mr. Raymond Burks, an African American with lived experience and a member of HHO’s Consumer Advisory Board.  The CRT will be responsible for all facets of the research as well as parallel planning, education, outreach, and dissemination efforts.  The CRT will be comprised of African Americans with lived experience and other key stakeholders. 

·     The CRT will conduct a community needs assessment to identify the disease or condition for intervention research using mixed research methods developed by the Center on Adherence and Self-Determination (CASD) Research core.  We seek to do this, in part, using innovative mobile assessment technologies developed by CASD investigators.

·     Results of the needs assessment will yield development of a corresponding intervention grounded in integrated care.

·     A pilot will be conducted to examine feasibility, acceptability, and impact of the intervention as well as the CBPR experience among the CRT.

Consumer Research Team (CRT)

The CRT is a group of eight members of Chicago's Edgewater-Uptown neighborhoods all of whom are African American's with lived experience with homlessness and serious mental illness.  A couple members of the CRT are currently homeless.  The CRT members are partners in all aspects of this research project and provide a perspective of lived experience. 

Top Row (from Left to Right): Robert Johnson, Chris Robison, Christina Jones, Raymond Burks, Pat Corrigan, Sonia Ballentine, Susan Pickett, Curlee Jenkins
Bottom Row (from Left to Right): Monica Williams, Dana Kraus, Rodney Lewis, Lee Taylor, Joyce Johnson


Below is a list of deliverables proposed for this project.  Click on the hyperlink to view the relevant resource.


-Windshield Tours

-Definition of the Problem

-Proposed Solutions

    -Qualitative Findings

    -Peer Navigator Manual

    -Peer Navigator Workbook