Informed Tenant Choice of Case Manager in Supportive Housing

Informed Tenant Choice of Case
Manager in Supportive Housing
Stacy Matuza, Program Director – Schermerhorn/575 5th Avenue
Aaron Levitt, Director of Research & Project Evaluation
Noemi Baez, Case Manager – 575 5th Avenue
Vancito Naar, Tenant – 575 5th Avenue
Center for Urban Community Services (CUCS), New York, NY
(Principal Investigator: Dr. John Jost)
History/Background (Stacy Matuza)
• Strengthening the recovery focus in CUCS supportive
 Wellness Self-Management
 Supported Employment
 {Person Centered Service Planning}
Goals of Tenant Choice
• Increase the opportunity for tenants to make choices that
would enable them to have more control over their
treatment and recovery.
• Obtain the best possible match between tenant and case
manager (CM).
The Pilot Setting
• The Schermerhorn, a supportive housing site located in
Brooklyn that opened in February, 2009
 Tenants
Formerly street homeless adults
Diagnosed with serious and persistent mental illness and/or HIV
 Services
Permanent, lease-based housing
On-site case management
On-site primary medical care
On-site psychiatric services
The Pilot Setting, cont.
• The Schermerhorn was chosen for the Tenant Choice pilot
 Both tenants and staff were relatively new to the program
 Relationships were less well-established and long-standing than
those at the other CUCS supportive housing sites
Elements of Tenant Choice
• Short professional biographies of each CM provided to all
82 tenants
• A “meet and greet” event held with all CMs
• Tenants were asked to submit their top 3 choices from
the 6 available CMs by the following week
• Tenants who chose not to attend the meet-and-greet
were given the choice form and asked to submit it
within one week
• CMs were asked to submit the names of up to five
tenants with whom they would particularly like to work
Tenant Choice Protocol
• All tenant choices and CM preferences were to be viewed
only by the Schermerhorn Program Director (PD)
• The PD first identified a subset of high-need/high-priority
• These tenants were to be matched to their first choice
CM unless the PD believed that person’s skill set was not
sufficient to meet the tenant’s needs
Protocol, cont.
• Non-high-priority tenants would be matched to their first
choice CM with two additional potential exceptions
 If assigning a tenant to his/her first choice CM would result in an
unbalanced caseload (e.g. many more HIV positive tenants than
other CMs), the PD would match the tenant to his/her second or
third choice CM
 If the caseload of the tenant’s first choice CM was already full,
the PD would match the tenant to his/her second or third choice
• 58 of 82 tenants submitted choice forms, and 33 attended
the “meet and greet”
• All but one tenant chose to remain with his/her current
• Tenants who did not submit a choice form remained with
their current CM
• None of the exception procedures within the protocol
were triggered
Refinements to Tenant Choice
• The meet and greet event has been eliminated
• On the day of a new move-in, the new tenant meets
with one of the supervisory staff who explains the
elements of Tenant Choice, reviews the biographies of
the available CM choices, and introduces the tenant to
those CMs
Refinements, cont.
• The new tenant meets with on of the potential CM
choices to complete move-in orientation
• The tenant is asked to submit his/her choice of CM
approximately one week after move-in
• The Program Director or Assistant Program Director now
meets with existing tenants to address requests to
switch CMs
Take Away Points
• The pilot reinforces the importance and practicality of
providing consumers of mental health services with more
control over their services and providers
• It is important to consider when and how consumers are
asked to choose their service providers
• At programs with lower pre-existing satisfaction, Tenant
Choice may result in more change in caseloads, which
could impact staff morale and other aspects of program
The Qualitative Study (Aaron Levitt)
• Research Questions
 How satisfied were tenants with their choices/matches?
 How well-informed were tenants’ decisions?
 To what degree did tenants value the option of choosing their own
 How did staff members experience Tenant Choice?
Study Design
• Semi-structured interviews with
 16 tenants who attended “meet & greet”
 15 tenants who only submitted a choice form
 nine staff members
• Baseline and six-month follow-up interviews
• Interviews were held with tenants who had been living at
the Schermerhorn for no more than four months at the
time of the “meet & greet”
Findings: Five Themes
• Choice was valued regardless of whether it led to change
• Pre-existing satisfaction drove tenant choices
• Personal qualities were valued over professional training
and work experience
• Staff concerns failed to materialize
• Tenants and staff disagreed regarding whether minimal
contact versus extended contact leads to better choices
and working relationships
Choice Was Valued Regardless of Whether It Led To
Change - Tenants
• “[Choice is] very important because I want to know that
my choice is important, that I have a choice.”
• “Just to know that my voice counted. That's very
• “It's empowering.”
Choice Was Valued Regardless of Whether It Led To
Change - Staff
“Having a choice makes tenants feel like, ‘Okay, I do
have some control over what my future holds and who I
work with and who provides me with services.’”
• “[Tenants] said that they never went into a place where
they actually had a choice of picking who they wanted
to work with.”
Pre-existing satisfaction
Less surprising to tenants than staff.
• Most tenants had no doubt about wanting to remain with
their current CM—some listed only one choice.
• Staff were somewhat surprised by the loyalty and
appreciation they perceived from tenants—perhaps due
to staff members’ initial anxiety of not being chosen.
Personal qualities valued over professional qualifications &
work experience
“Their credentials does not mean anything to me.”
• Qualities noted as important to tenants
 “a person that would go out of their way”
 “the content of his/her heart and his/her mind”
 “the feel you get with a person, the rapport”
 “caring and understanding of my situations and
Staff Concerns Failed to Materialize - Concerns
• Increased or otherwise altered caseloads
• Not being picked
• Needing to ‘sell’ oneself in one’s biography
 “It could become a [beauty/popularity] contest”
Staff Concerns Failed To Materialize - Reality
• There were no noticeable changes—Tenant Choice was
smoothly piloted.
“It just happened.”
• Staff focused on stronger relationships with tenants as a
result of Tenant Choice.
“I think it just assures us that our tenants are
committed to working with us because our tenants could
have bowed out.”
Does Minimal Or Extended Contact Lead To Better
Choices? - Tenants
Stressed the importance of getting to know a person and
working with him/her over time.
• Emphasized the need to be able to communicate with
and feel comfortable with a CM, and believe the CM was
advocating for them.
“You really can’t tell until you meet the person and get
to know them what they’re about."
Does Minimal Or Extended Contact Lead To Better
Choices? - Staff
Tenants should choose their CM as soon as possible after
moving in.
• Minimize contact with CMs prior to clients making a
choice — provide more of a “pure choice” and a better
tenant/CM fit.
• New tenants almost always choose the person they first
meet; doubt whether tenants consider their other
Direct Service Staff Perspective on Tenant Choice
(Noemi Baez)
• Experiences at CUCS
 The Kelly transitional services
No client choice of worker
 The Schermerhorn
Participant in Tenant Choice pilot project
 575 Fifth Avenue
Assisted with Tenant Choice implementation at this new supportive
housing site
Tenant Perspective on Tenant Choice (Vancito Naar)
• Borden Avenue Shelter
 Had a case worker
 Was pleasant
 Was fortunate enough to get a good worker
Experience at CUCS
• Moved in June 2011
• Started working with a temporary worker
• Presented with the opportunity to pick your worker
• Felt empowered and in control of your life; didn’t feel
like a number
CUCS, cont.
• I chose worker because
 Worker was dedicated to us
 Got a good vibe from worker
• You ask the questions, and we’ll do our best to answer!