Abstract
Hypermarginalized populations, such as homeless drug users with acute health problems, are subject to multiple intersecting adversities that result in social exclusion and chronic suffering. Despite this population's high need for health and social services, institutions provide services that are fragmented and often punitive, contributing to further marginality. In this article, we present a hybrid methodological approach that combines clinical social work and ethnography in a study of intensive case management for HIV-positive indigent adults in Oakland, California. We investigate two primary research questions. First, we consider the challenges this population faces in navigating institutions to meet their basic needs, and we demonstrate how organizational irrationality has severe consequences for this population. Second, we grapple with the question of how to ethically engage hypermarginalized participants in research by presenting a clinically informed intervention that is responsive to individual vulnerabilities and also enhances our understanding of institutional failure.
- Copyright © 2015 by Russell Sage Foundation. All rights reserved. Printed in the United States of America. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Reproduction by the United States Government in whole or in part is permitted for any purpose. This research was supported by funding from the National Institutes of Health (R01MH094090, PI: Kral; R01DA033847, PI: Comfort; and R01MD007679, PI: Lorvick). We thank Jay Borchert, Elizabeth Kita, Reuben Miller, Victor Rios, Megan Tompkins-Stange, Damian T. Williams, and the participants in the Russell Sage Foundation “Severe Deprivation in America” conference for their invigorating and helpful feedback on drafts of the manuscript. We are particularly grateful to special issue editor Matthew Desmond for his detailed comments and insightful suggestions. And we are tremendously appreciative of and indebted to the people who participated in our research, and hope that we have done justice to the experiences they shared with us. Direct correspondence to: Megan Comfort at mcomfort{at}rti.org, Andrea M. Lopez at alopez{at}rti.org, Christina Powers at cpowers.contractor{at}rti.org, Alex H. Kral at akral{at}rti.org, and Jennifer Lorvick at jlorvick{at}rti.org; all authors at RTI International, 351 California St., Suite 500, San Francisco, CA 94014.
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