The changes that have taken place over the last few years in the behavioral health field are affecting the way staff view “clients” as well as the way these same “clients” are being helped to view themselves. There is a swirl of information and expectations, and government funding is changing (and seemingly decreasing). Managed care means the government is paying for outcomes, not for individual services. The question then remains, with all that is changing, how do you maintain a focus on recovery for both your clients and yourself?
Agencies at the forefront of change are utilizing evidence-based practices, harm-reduction, and strength-based approaches. These changes encourage staff to rely more on relationship building and clinical skills, which continue to improve overall quality of services and supports and vastly increases quality-of-life measures.
The changes occurring from the transition to managed care are further complicated by New York City’s housing market. Supported housing apartments are funded on an annual per-person bed rate. The money given needs to cover both rent subsidies and the services people need to maintain their independence. According to a survey conducted by the Office of New York City Comptroller Scott M. Stringer, from 2000 to 2012, median apartment rents in New York City rose by 75 percent (compared to 44 percent in the rest of the country). Yet the per-person bed rate did not meaningfully increase within that same time period.
Agencies offering Supported Housing have had to acquire more two-bedroom apartments and then move people who have been living on their own into the shared space. How does staff support people through this transition? How do we get folks to focus on recovery while keeping up with system changes? We emphasize recovery and goals and make them a priority.
Why has the move from one-bedroom to two-bedroom apartments become more common? Well, in New York City, gentrification has been spreading across the boroughs like wildfire, while the demand for affordable housing is also growing by leaps and bounds. Although gentrification may make a neighborhood more appealing, it also makes it more expensive. People moving into a gentrified neighborhood may not want Supported Housing in their community. It is then up to staff and residents to show that they have been steady and reliable neighbors for years. Staff also needs to work with people facing a gentrifying neighborhood by empowering them and stressing that the neighborhood belongs to everyone. Continued advocacy efforts can be achieved by supporting legislation that will protect the right for our folks to continue residing in these up-and-coming neighborhoods and allow them to feel worthy and included.
A case manager asked me how someone who’s been living in a one-bedroom apartment for 15 years is supposed to feel good about moving into a two-bedroom apartment with a roommate. My short answer centers on how a roommate can counter the effects of chronic isolation. My long answer entails different ways of getting people onboard. Under the frame of recovery-oriented practice, you give people options, take your time to match folks, and have people meet each other and get to know each other before making a final move. You also give people the opportunity to look at different apartments, apartments that you yourself would reside in. You remind folks of their resilience and ability to adapt and stress the importance of social connectedness. Just like with any road to recovery, you inform people that setbacks with a roommate are normal and expected and that dealing with issues offers them an opportunity to try a different approach next time a problem arises and to learn more about themselves.
What about staff? They too are often affected by system changes and have to realize that their own needs should have priority and need advocacy as well. When helping staff, I find it useful to have a holistic approach and to encourage them to take care of their overall well-being. As a supervisor, I emphasize the importance of managing our physical and mental health in and out of work. I promote self-care and model it during supervisions, staff meetings, and other regular encounters. This should be accomplished in the context of recovery principles: Build on staff strengths, offer them different options to make their workload more manageable, incorporate peer support to take on some of the responsibilities, and constantly remind them the purpose of the work by sharing stories of how people have gotten better as a result of their efforts.
In the midst of system reform, you maintain a focus on recovery by including it in your everyday language. You allow it to become the frame of practice and integrate recovery principles to everything work related, from staff interactions to the people residing in Supported Housing.