Mental Health
Special Interest Section Quarterly

Volume 25, Number 2 • June 2002
Published by the American Occupational Therapy Association, Inc.

Supportive Housing Occupational Therapy Home Management Program

Table of Contents:

■ Christine Nolan, OTS; Peggy Swarbrick, MA, OTR

Historically, persons with mental illness were isolated from the community in institutional environments, and the outlook for these persons’ future was one of hopelessness and life-long dependency (Srebnick, Livingston, Gordon, & King, 1995). Long hospitalization caused persons to lose basic living skills and assume dependent, patient roles. From the 1950s to the present, persons with mental illness have been considered as “patients”; “clients”; and, most recently, “mental health consumers” (hereafter the term mental health consumer will be used to identify persons with mental illness), with a parallel shift in emphasis of service delivery toward providing services in the community that promote citizen roles rather than patient roles (Carling, 1995). The term consumer connotes a person with mental illness as a citizen, who has rights, has responsibilities, and can be empowered to live in a safe and decent home in a community of their choice with flexible supports based on personal preferences, life goals, and personal aspirations.

The supportive housing program model offers access to permanent lease-based housing and service supports, such as case management services, employment assistance, and linkages to other needed community resources (Carling, 1993, 1995). In the broadest sense, the model is housing linked with services. Housing and services are interdependent; both are less effective in the absence of the other (Glauber, 1996). Housing is permanent, and the consumer may remain in the housing as long as they he or she adheres to the requirements of the lease.

Housing can include single-room occupancy, apartments, or scattered-site units. Supportive housing programs provide access to an array of services, including, but not limited to, 24 hr, 7 day a week crisis intervention; medication monitoring support; wellness promotion; transportation; assistance with activities of daily living; linkage to educational and employment opportunities; and housing assistance. Permanent housing and access to services and supports are crucial for people to live independently, and studies have demonstrated that supportive housing increases stability and decreases hospitalization rates among mental health consumers (Rog, Holupka, & Brito, 1996).

The supportive housing model (Carling, 1993, 1995) is quite different from the traditional residential programs that congregate unrelated adults in supervised settings with rules and restrictions. Some traditional residential programs are transitional, requiring persons to move from place to place, which often can cause instability and crisis. Supportive housing for mental health consumers evolved from consumer preference studies indicating that consumers want permanent homes with flexible supports (Minsky, Riesser, & Duffy, 1995). It is recognized that recovery from mental illness is a unique journey that does not conform to a fixed set of program expectations. The supportive housing program fosters a person’s growth through support of risk taking and expression of individual choice.

Collaborative Support Programs of New Jersey (CSP-NJ), a consumer-run agency, was one of the first agencies in New Jersey to implement a supportive housing program. The CSP-NJ conducted surveys that indicated that traditional methods of serving the housing needs of mental health consumers were inadequate and in need of change and that consumers prefer to live in a safe community environment rather than in institutional settings or boarding homes (CSP-NJ, 1991). Consumers desired participation in community activities with support, but not supervision, and access to ongoing supports whenever necessary (CSP-NJ, 1996).

Supportive housing program staff members work collaboratively with consumers to enable consumers to acquire community living skills in ways that do not require them to participate in simulated preparatory programs. The staff collaborates with consumers in the consumers’ homes. Consumers learn practical living skills and gradually become less dependent on staff. Support workers work flexibly and creatively to respond to individual changing needs. Staff members function in the role of mentor and coach, recognizing personal goals and choices, acknowledging the individual’s capacity to take risks and be successful, celebrating achievements, and affirming the individual’s quest for personal growth and unique path to recovery. The Supportive Housing Association of New Jersey (2001) Outcomes Committee outlined the elements of an ideal, quality supportive housing program model (see Table 1). This article describes how occupational therapy students worked with an occupational therapist to develop a home management program for a supportive housing program.

Table 1
Elements of Ideal, Quality Supportive Housing

Note adapted from Quality Standards Instrument by The Supportive Housing Association of New Jersey, May 2001, NJ: Author.

Emerging OT Role(s)

Occupational therapists have a long history of working with mental health consumers to address self-management and self-care goals. However, many therapists have remained in institutional settings and have been slow to define their role in community-based settings. A client-centered approach is one in which an occupational therapist embraces a philosophy of respect for and partnership with persons receiving services (Law, Baptiste, & Mills, 1995). The role for occupational therapists who embrace a client-centered approach is to help consumers live as independently as possible in the community and move toward self-sufficiency.

An occupational therapist working in a management role in a community-based supportive housing program worked with Level I occupational therapy students from Kean University of New Jersey to develop the home management program in partial fulfillment for students’ academic program development course. Home management has been an ongoing challenge for the many consumers living in the supportive housing program, the supportive services staff, and the property management staff. The students conducted assessments with consumers and staff to define the needs and contents of a home management program. An interest survey was disseminated to current consumers and staff members to determine interest in participating in the program. Based on the survey results, the consumers expressed an interest in learning home management skills. Staff also supported the need for the program.

Level II occupational therapy students working at the agency have been implementing this program. Four students have implemented the program over the past year. Students have been training support workers on how to follow through with strategies and enhance consumer progress. Kean University master’s degree students currently are evaluating this program through interviews with consumers and staff members to identify program impacts.

Development and implementation or this home management program by occupational therapy students has enlighten agency staff of the value of occupational therapy in a community-based supportive housing program. The agency currently is planning to hire a part-time occupational therapist to implement the program statewide.

Program Components

The home management program was designed to teach consumers the skills necessary for supporting and managing their homes safely, successfully, and independently. The program focuses on the five areas of home management as shown in Table 2.

Table 2
Areas of Home Management

Criteria for Participation

Consumers are recommended for the home management program based on their own stated preference for developing home management skill or support and property management staff recommendation based on the outcome of quarterly home inspections.

Challenges and Obstacles

Challenges and obstacles to independent home management were defined through focus group meetings with consumers and support services workers. Table 3 lists and describes these challenges and obstacles.

Table 3
Challenges and Obstacles

Case Study

Joe (pseudonym) is a 40-year-old man affiliated with the supportive housing agency since fall, 1993. His diagnosed condition is schizoaffective disorder. Joe was informally interviewed and evaluated using the Home Management Evaluation, developed by Kean University OT students., in his apartment. The findings are presented in the following paragraphs.

Joe is cooperative, is friendly, dresses appropriately, and appears comfortable in the presence of others. He reports that he has a close supportive relationship with his family, especially his mother. Pictures of his family are displayed throughout the apartment. He lives alone in a one-bedroom, second-floor apartment. The apartment also includes one bathroom, a living room, a dining area, and a kitchen.

Joe identifies several current interests, which include reading, music, golf, bike riding, and softball. Joe works a few hours a week at a consumer-run program.

Joe does not require physical assistance with home management tasks but currently requires standby support and verbal cues to initiate the majority of the home management tasks in the kitchen, bathroom, living room, and bedroom. He is aware of the need to improve this area but needs a lot of encouragement for follow through. In addition, Joe tolerates approximately 10 minutes of continuous activity at a time before needing a break.

 Joe’s long-term goal is to independently clean the bathroom, living room, bedroom, and kitchen once a week, 80% of the time, using the Home Management Checklist. The objectives are as follows:

• Confirm verbally knowledge and understanding of consumer Home Management Checklist.

• Develop a written weekly home cleaning schedule, with the materials needed, with stand-by support.

• Clean bathroom once a week, following the bathroom section of the Home Management Checklist, with support, 80% of the time, with no verbal cues.

• Clean living room once a week, following the living room section of the Home Management Checklist, with support, 80% of the time, with no verbal cues.

• Clean bedroom once a week, following the bedroom section of the Home Management Checklist, with standby support, 80% of the time, with no verbal cues.

• Clean kitchen once a week, following the kitchen section of the Home Management Checklist, with standby support, 80% of the time, with no verbal cues. ■

Acknowledgment

This project was completed during Level II fieldwork placement, Collaborative Support Programs of New Jersey.

References

Carling, P. (1993). Housing supports for persons with mental illness: Emerging approaches to research and practice. Hospital and Community Psychiatry, 44, 439–449.

Carling, P. (1995). Return to community: Building support systems for people with psychiatric disabilities. New York: Guilford.

Collaborative Support Programs of New Jersey. (1991). Consumer housing preference survey: Results and executive summary. Unpublished manuscript.

Collaborative Support Programs of New Jersey. (1996). Boarding home resident survey for Monmouth and Ocean County. Unpublished manuscript.

Glauber, D. (1996, July/August). The evolution of supportive housing. Shelterforce, 12–13.

Law, M., Baptiste, S., & Mills, J. (1995). Client-centered practice: What does it mean and does it make a difference? Canadian Journal of Occupational Therapy, 62, 250–257.

Minsky, S., Riesser, G., & Duffy, D. (1995). The eye of the beholder: Housing preferences of inpatients and their treatment teams. Psychiatric Services, 46, 173-176.

Rog, D., Holupka, S., & Brito, C. (1996). The impact of housing on health: Examining supportive housing for individuals with mental illness. Current Issues in Public Health, 2, 153–160.

Srebnick, D., Livingston, J., Gordon, L., & King, D. (1995). Housing choice and community success for individuals with severe and persistent mental illness. Community Mental Health Journal, 31, 139–152.

The Supportive Housing Association of New Jersey (2001, May). Quality standards instrument. Cranford, NJ: Author.

Christine Nolan, is Occupational Therapy Student, Kean University, Masters Program, Union, New Jersey. Peggy Swarbrick, MA, OTR, Associate Director, Collaborative Support Programs of New Jersey (a consumer-operated organization), 11 Spring Street, Freehold, New Jersey 07728.

Nolan, C., & Swarbrick, P. (2002, June). Supportive housing occupational therapy home management program. Mental Health Special Interest Section Quarterly, 25, 1-3.