Informed Tenant Choice of Case Manager in Supportive Housing

1. 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)

2. History/Background (Stacy Matuza) • Strengthening the recovery focus in CUCS supportive housing • Wellness Self-Management • Supported Employment • TENANT CHOICE • {Person Centered Service Planning}

3. 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).

4. 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

5. The Pilot Setting, cont. • The Schermerhorn was chosen for the Tenant Choice pilot because • 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

6. 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

7. 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 tenants. • 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

8. 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 CM

9. Participation • 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 CM • Tenants who did not submit a choice form remained with their current CM • None of the exception procedures within the protocol were triggered

10. 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

11. 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

12. 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 operations

13. 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 workers? • How did staff members experience Tenant Choice?

14. 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”

15. 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

16. 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 important.” • “It's empowering.”

17. 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.”

18. 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.

19. 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 circumstances”

20. 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”

21. 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.”

22. 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."

23. 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 options.

24. 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

25. Tenant Perspective on Tenant Choice (Vancito Naar) • Borden Avenue Shelter • Had a case worker • Was pleasant • Was fortunate enough to get a good worker

26. 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

27. CUCS, cont. • I chose worker because • Worker was dedicated to us • Got a good vibe from worker

28. Q & A • You ask the questions, and we’ll do our best to answer!