second dmhstaff survey report (non-nimh)

This report presents the results of a survey of staff employed in Metro Boston's three shelters for homeless mentally ill persons. The survey explored staff perspectives on their clients, their work, their shelter and the surrounding service system, as well as staff reactions to the NIMH research demonstration project headed by Dr. Stephen M. Goldfinger. A prior report presented the survey results pertaining to the NIMH project. This report describes the work performed by staff and their orientations to the various aspects of their work experience. Differences between the three shelters are identified and policy implications are discussed.

The Massachusetts Department of Mental Health funds three Boston shelters for seriously mentally ill homeless adults. Two shelters are operated directly by DMH; the other is run by a private nonprofit agency under contract to DMH. Most shelter residents are recruited from the generic shelters by a DMH outreach team. Each DMH shelter offers regular bed assignments, storage space, various programs and activities, connections to day programs, and support staff, including nurses, case managers and counselors.

These three shelters represent an innovative approach to meeting the needs of homeless mentally ill persons. While most shelters mix mentally ill persons indiscriminately with others, the DMH shelters allow an exclusive focus on the unique problems and needs of mentally ill persons; in consequence, stability is stressed and multiple rehabilitative programs are offered. Unlike institutional treatment approaches, however, the DMH shelters allow shelter users to remain involved in the surrounding community and their staff help make service connections to other agencies.

It is shelter staff who carry out the work of the shelter and who shape, through their actions and attitudes, the experience that shelter guests have. It is shelter staff who must translate abstract shelter policies into concrete activities; it is shelter staff who interact daily with shelter guests, and who learn through direct experience of the effectiveness or ineffectiveness of shelter programs.

The perspectives of shelter staff thus provide a revealing picture of the nature of the DMH shelters as organizations. By describing staff perspectives on their shelter's mission, on their clients' problems, on their jobs and on the service system, successful approaches can be highlighted and service difficulties exposed.

Parker Street Central shelter opened in 1981 and provides beds for 40 guests. Because it is housed in a mental health center in downtown Boston, the shelter provides numerous daytime opportunities for participating in mental health programs and for more recreational pursuits. At the time of the survey, the shelter employed 24 staff--22 in client contact positions: a director, a clinical coordinator, a housing coordinator, a case manager, three nurses, three shift supervisors, three assistant shift supervisors, and nine mental health workers (one of whom worked part-time).

Parker Street West provides beds for 17 guests on the edge of a public park, next to the Shattuck Hospital in Boston's Jamaica Plain neighborhood. The shelter opened in 1986. At the time of the survey, it employed 17 staff, all but two in direct client contact positions: one part-time director, three nurses, one case manager who also served as housing coordinator, four shift supervisors and six mental health workers (one part-time).

The Bay View Inn also opened in 1986, and since late in that year has been operated by the VinFen Corporation. Bay View is located on Long Island in Boston's harbor; clients are bused to it each night. The shelter provides beds for 36 guests; unlike the other two shelters, which partition former gymnasiums into cubicles having several beds each, the Inn provides 4-5 beds in each of several rooms. Bay View was run at the time of the survey by a staff of 31, all but one of whom were in direct client contact positions: one director and an assistant director, two case managers, four nurses, one activities coordinator, three shift coordinators, and 18 residential counselors (three of these were in "senior" positions, while five were part-time employees).

Upstairs from the Inn is Andrew House, a unique detoxification service specificially for substance abusers who also are mentally ill. As a result of the propinquity of Andrew House, the Bay View Inn is host to many more substance abusers than either of the other two shelters. Inn staff offer several programs for shelter guests each week, including Alcoholics' Anonymous meetings and movie nights. The Inn does not itself provide a housing coordinator, but relies on DMH CMHC-based case managers for assistance with housing placements.

METHODOLOGY

The DMH Shelter Staff Survey was conducted in May and June of 1991. All staff were given self-administered questionnaires to complete; at Parker Street Central and Parker Street West, staff mailed their completed questionnaires to me at the University. At Bay View Inn, staff sealed their questionnaires in an envelope and left them in the shelter office; I then drove out to the shelter and picked up these questionnaires. Completed questionnaires were returned by 85 percent of the staff.

In addition to the self-administered questionnaires, thirty-two of the 67 staff in service positions at the three shelters were interviewed using a semi-structured interview schedule. Staff were selected for interviews using a stratified sampling plan: All directors, case managers, housing coordinators, day and evening shift supervisors and head (or day) nurses were interviewed and a simple random sample was drawn of one-third of the other employees. Administrative assistants, clerks and housekeepers were excluded from the sampling frame. Two staff members in the initial sample (of 34 employees) were laid off as the study began and were not approached for an interview; interviews were completed with all other employees in the sample.

Most of the interview questions concerned issues also addressed in the questionnaires, but the open-ended nature of the interview questions allowed respondents to describe their ideas and feelings in more depth. In the report, staff illustrative interview comments appear after the tables in which the corresponding quantitative questionnaire data are presented. Responses to interview questions that did not parallel the questionnaire items are presented in separate sections.

Distributions of responses to all questionnaire questions are presented in dichotomous form in order to facilitate comparisons between the three shelters and across different questions. The detailed frequency distributions for each question are available from the author.

FINDINGS

Survey findings are presented in five general sections: shelter philosophy, perspectives on clients, perspectives on work in the shelter, satisfaction, perceived changes in the shelter, and staff backgrounds. Staff recommendations for their shelter are incorporated in the final discussion of policy implications. Shelter philosophy and perspectives on clients are presented first in order to highlight the shelters' service approaches.

Shelter Philosophy

There was no consensus among staff at any of the three shelters on shelter philosophy, or mission. Some stressed the importance of helping clients to prepare for moving into housing; other staff emphasized the provision of support services for clients. And some staff did not believe that their shelter had a philosophy.

Several Parker Central staff suggested that their shelter did not have a clearly articulated philosophy.

ever since I have been here the question is: what is our mission. the shelter philosophy is basically to provide a transitional setting. I think it is very unclear whether we are treatment or custodial. this place would work great without all the fancy people like me [a professional] in lots of ways. people manage fine on the weekends without us. I think a lot of time is spent on talking about treatments and treatments and treatments. It is a discouraging population. if you look back 10 years ago, people were talking about the same things, people are very chronic here. so I don't know what we are really doing. we try to provide good care but I don't know if we are really doing that or how necessary it is. maybe we should just leave people alone. (PSC)

"being there and support for people." (PSC)

I guess the philosophy dealing with the guests is from what I have gathered in staff meetings and talking with the other personnel, it is greater independence for the clients. we had trouble in the past defining what the shelter is and an overall philosophy. PSC

At the Bay View Inn, most staff defined the shelter's philosophy in terms of the provision of support services.

I would say that the shelter philosophy at this time is to provide client-centered treatment, agreed upon and worked upon by the client, the program, the mhc, to best enable and empower the client to function at their best level, and to provide awareness and education for substance abuse and maintaining people's sobriety.BVI

to take in homeless dually diagnosed clients and try to rehabilitate them to as much as it is possible here at the shelter and send them on, if possible. BVI

I believe the goal of the shelter is to help people to get back on their feet again, to readjust, to get hooked up with services, and to be able to function at higher level than they were able to when they came. or they had attained before and whatever happened to make them homeless. I think that philosophy is understood by staff and clients and I think everybody works on that.BVI

The NIMH project seemed to have had a large impact on staff perceptions of the philosophy of the Parker Street West shelter, although not all staff perceived a clear emphasis on housing readiness.

The shelter philosophy has shifted from having an emphasis on being transitional, to getting people out, to that as THE goal. We get people in and get them ready to move out. The NIMH program is the impetus to that, like ....PSW

I would say pretty much. get people housing, into a better environment, help them to stand up on their own feet if it is possible. it doesn't always work out that way. sometimes I think they are pushed too quick. some, not all. sometimes I think they stay too long. but I think some have been pushed out and were not ready. there was no way that they were ready. goals of the shelter stayed the same. I think the goals are good. they can't be in a shelter all their life. they shouldn't be in the street. some can do it almost on their own. they only need feedback like go and check it out and see how it goes. others need a lot of structure. PSW

I can't think of any. I can't give you any slogan. PSW

no, not at this point. I think it got lost within the last 2 years with all the changes. PSW

I think so. I think the philosophy here is just to treat the guests like a human being. and we are here just to assist them and to keep them safe, and to see that they get alright, make a transition possible. PSW

Perspectives on Clients

Staff perceptions of shelter guests' health problems were measured by asking staff to estimate the percentage of their guests who were mentally ill, abused drugs or alcohol and were physically ill. Estimates varied between these health problems and between shelter.

The average staff estimate of the percentage of shelter guests who were chronically mentally ill was just over three-quarters. Two in five guests were estimated as abusing alcohol; the same percent were estimated as abusing drugs. Physical illness was estimated to be a current problem for one in five guests.

Three of these four estimates varied between the three shelters. Estimates of chronic mental illness were substantially higher at Parker Street Central (almost nine in ten) than at either of the two other shelters (about seven in ten). Substance abuse was estimated to be less prevalent at Central (about one in five), somewhat more common at West (almost two in five), and most common at the Bay View Inn (almost three in five). Estimates of physical illness or injury did not vary appreciably between the three shelters.

Percentage of Guests Who Have ...

(mean percent)

PSC PSW BVI Total

Chronic Mental Illness 88 69 73 77

Alcoholism or Alcohol Abuse 19 38 56 41

Drug Abuse/Addiction 19 34 57 41

Physical Illness or Injury 22 17 18 19

Illness was most often identified by staff as the reason for their guests' homelessness: almost three-quarters agreed or strongly agreed that "The shelter's guests became homeless due to their illness." About half agreed that neglect by the service system was a cause of their guests' homelessness, compared to just one in five who identified neglect by families as a cause and only four percent who believed that the shelter guests were themselves largely responsible for their homelessness.

Parker Street Central staff were more likely than staff at the other two shelters to view the causes of guests' homelessness as due to illness and service system neglect. Parker Street West staff were somewhat more likely to focus on family neglect and individual responsibility than were staff at the other two shelters.

Cause of Guests' Homelessness

(percents)

PSC PSW BVI Total

Guests are Homeless Due to...

Their Illness 95 67 61 74

Neglect by Service System 60 44 39 47

Neglect by Families 20 33 18 21

Largely Responsible for Own Homelessness 0 11 4 4

Comments by staff who were interviewed reveal more complex explanations for homelessness than could be captured in the questionnaire with its fixed-choice responses. Mental illness was most often mentioned, although substance abuse was identified by many staff at the Bay View Inn as the underlying problem.

mental illness. just watching them, my heart goes out to them. whatever the circumstances were that were in their lives that led them to the streets and being homeless I see it as very sad. it's just more but for the grace of god. I don't want to say good luck, bad luck but sometimes it's really tough. maybe the resources weren't there for them. or maybe they didn't have the capabilities to know when the resources were there.. it is misfortune. and suffering from a mental illness and alcohol and drugs.BVI

I believe because of their mental illness that's why they are homeless. so for them to say I would rather live on the street than live in a house and to pay rent, I mean that to me indicates that they are mentally ill. PSC

Some staff believed that the impact of mental illness and substance abuse on likelihood of becoming homeless could only be understood in the context of the availability of family or social service supports.

I think that there is like this revolving door thing, with service policies, which doesn't meet many of the needs of people. I see this with a lot of the younger people, the younger substance abusers. and what frightens me too, the way, at least it looks like, we are bending more towards a purely crisis intervention system. so I think we are going to see a lot more people going in, having real short hospitalizations and being discharged to the streets which is like pathetic. and also there is a fragmentation of the system where like somebody is a lindemann client but they all have like east boston counseling or d street psychiatric services and you know, maybe go to mass rehab, and then they have people here. there is this sort of real lack of cohesive services. PSC

I feel that the majority has either lost support in their lives or never had it. I think the illness is more or less secondary. the majority comes from families that are dysfunctional or families that had no understanding of the illness. case after case they would talk about how they were thrown out of their house, family members couldn't take it any more. they did not understand them. and then they seem to get into the habit of shelter life. and it seems to be something that gets familiar to them. they get into their own little group. it's its own support system. you end up having your own sort of group. PSW

In spite of the low level of agreement with the "individual responsibility" explanation as posed in the questionnaire, some staff explained in the interviews that they believed the shelter guests were responsible to some extent for their homelessness.

some of them just have taken the money that they have earned or whatever and they gamble. some folks refuse to work, they don't want to work. but I would say probably all of our guests have one form of schizophrenia or another.... these folks are homeless because they don't want to pay rent, they don't want to clean their clothes, they want to smoke and drink and do whatever they want. PSC

if you have a member in the family who is drunk all the time and terrorizes the rest of the family and refuses to get any kind of help and is confronted by the family, you have to stop or you have to leave. and there is no way to put this question because of age or because of the state's statute into a hospital where they are forced to get help, then in a sense it is 80% their fault. regardless of someone's illness, mental or whatever, there's got to be some responsibility on that person's part. and if my mother says, you can't stay here, go and get some help, and they got all the services in place and they refuse and you continue to terrorize and that kind of stuff and then they say you are out, you are pushing it and you have to stay in a shelter, you are probably responsible for that. PSC

I would say essentially people are homeless because of deinstitutionalization, essentially. I mean if we really look at the big picture people are homeless because of deinstitutionalization because deinstitutionalization didn't work because the community does not want to accept people who are mentally ill. there are some individuals, I hate to use the word, but there are some individuals who I really believe have a fascination with living on the street, living a live style that they become accustomed to, where they develop friends and peers and relationships and network among themselves. PSC

I think a lot them are homeless because they are on drugs, I don't know, got laid off, got tossed out of their home. A lot of them are just mentally ill and are not accepted by the community at large and end up being homeless because they can't cope. and a lot of them choose to be homeless. a lot of them just choose to be that way. I shouldn't say a lot, I should say some. BVI

DMH shelter staff tended to view shelter guests as having problems that required professional assistance. Almost all staff believed that shelter guests need a lot of social services. About half of the staff agreed that few shelter guests were ready to live on their own, while two in five believed that shelter guests were just people who had had some bad breaks. One-third of staff believed that guests tend to lose their medication or take it improperly. One in five staff believed that guests were too impaired to manage on their own; a similar proportion agreed that guests could live in regular housing if they wanted to.

These perceptions of guests varied somewhat by shelter. Staff at the Bay View Inn were somewhat more likely than those at the two Parker Street shelters to agree that few guests were ready to live on their own and somewhat less likely to see guests as people who have had some bad breaks; nonetheless, staff at the Bay View Inn were least likely to believe that guests were too impaired to manage on their own or that many guests lose their medication. These perceptions may reflect reactions to the greater prevalence of substance abuse among Bay View Inn guests--the guests were not seen as ready to live on their own due to substance abuse, but as not so impaired to manage on their own except for the substance abuse.

Shelter Guests' Service Needs

(% Agree and Strongly Agree)

PSC PSW BVI Total

Need Lots of Social Services 100 100 92 94

Few Ready to Live on Own 35 44 61 49

Guests are People who have Bad Breaks 40 56 32 39

Many Lose Medication or Take Improperly 55 38 14 32

Too Impaired to Manage on Own 35 33 11 23

Could Live in Regular Housing if Wanted 15 0 21 16

When asked about guests' readiness for independent living, staff estimated that less than one in five were ready to live on their own without help. Somewhat more were estimated to be ready for independent living with help (44%) than were thought not ready to live on their own (38%). Parker Street Central staff estimated that about three-quarters of their guests were ready to live on their own, with or without help, while staff at the other two shelters estimated that about six in ten guests were ready to live on their own.

Guests' Housing Readiness

(Mean percent)

PSC PSW BVI Total

Ready to Live on Own Without Help 16.5 9.9 15.6 14.8

Ready to Live on Own if Helped 54.2 51.1 34.3 44.5

Not Ready to Live on Own 25.7 40.6 44.7 38.2

In the interviews, staff emphasized the small proportion of shelter guests who were capable of living on their own, and also explained why support services would be necessary for most.

I say more than half. definitely with help. especially the ones that have been here a long time. it seems like that people who have been here from 6 months to a year it would be easier for them as oppose to those who have been here 3 years. because they get comfortable. we are trying our best to let them do chores, give them tokens so that can get ready. PSC

I don't think many, just a few. most of them need help. a lot of our clients are hearing voices and they need to be reassured that it is not true. I think they need a lot of help. PSC

independently on their own, about 20% of them. a lot of them now have payees. if they were to live independently they should keep the payees because they are tempted to, most of them have a drug and alcohol problem, and they are tempted to spend it on that rather than on rent. they definitely need help. they should have a lot of visits. they are not going to take their meds. a lot of them deny the illness they have. they refuse to take their meds.BVI

I think if you include those who need support it would be a good 80%. I think they could. I think there are probably 20% that are so lacking some of the skills you need to be on your own and don't have enough support, especially social that I don't think they are able to have a relation here. BVI

One respondent emphasized the difficulty of using client preferences to determine whether the client was capable of independent living.

without a group home I'd say 10%. the people who are opting to live alone are not always the wellest. sometimes they are the craziest people. they are going out and somehow gotten themselves apartments and have moved into it and you predict it won't be long. you give them six months and then there will be a hospitalization or something. so the ones that are actually capable of it are not the ones who ask for it. PSC

About nine in ten staff at each of the shelters agreed that shelter guests should be charged a portion of their income to stay at the shelter. Just over one-quarter of the staff agreed that their relations with shelter guests "tend to be personal and close"; although this sentiment was somewhat more common at Parker Street West--the smallest of the three shelters. Almost no staff thought they should avoid intrusive service procedures with guests.

Service Approach, Preferences

(Percents)

PSC PSW BVI Total

Should Charge Money for Staying 90 89 86 88

Relationship with Guests is Personal 20 44 29 28

Staff Should Avoid Intrusive Procedures 0 0 8 4

All but one of the staff members who were interviewed favored charging guests for staying at the shelter; most felt that this approach would better prepare the guests for independent living. Some staff made specific proposals for how much money should be charged and when.

charging guests? I'd think that would be wonderful, I really do. I think they need to get that responsibility. especially if they are going to move out into apartments and hopefully some day get a job. and they need to be responsible. and I think when they're living here, they should pay something, I really do. that's a definite, I always felt that way. in fact when I first came here I was very surprised, when I found out that they didn't pay anything. in a shelter, I think, they should contribute something. BVI

Yes, I do. ...I think 50 percent is too high in my opinion, but I think that even 35-40% is probably more on target. And maybe after a year for it to go up to 50 or even 60 percent if, ah, once people are here again, we've had people here for almost 5 years now, because we don't charge rent. If they refuse to leave, we can't kick people out of here, so, if they refuse to leave, then our hands are sort of tied. Well, and you know, once people are here for a certain period of time it sort of becomes their home, it's very comfortable, it's very safe and familiar to them, so, you know, some people just don't want to leave, so if there is some type of monetary fee involved, maybe that will at least show them they're taking responsibility for at least making a decision to live here, rather than just staying here, you know, without paying anything. BVI

[charging guests? good idea?] I do. you know, even if you keep it as a saving until the day they go into housing, they could get it. I do because I think if people rely on getting everything free, their eating and drinking ???, I think even a small portion and that will help them to budget. some of them have been here so long and they are not paying, obviously when they are going somewhere, you know, they think they shouldn't pay anything. and I think that is wrong. not just here, in every shelter this is what's happened. keep the money until they are going away. on their check what we should do is that they have to save 40%. it will be returned back to them when they leave because when you settle in a new place you need this, you need that. but I don't believe having all that money just to spend on tonics or whatever, you don't learn responsibility. I think we do have to charge guests. PSW

Most staff indicated in interviews that they keep their relationships with guests on a professional level, although they differed in the extent to which they felt their relations with guests were close.

Close enough. I have a fairly intimate relationship with half of the guests. but then there is different levels of it. with some of them I am very close. what I tend to do in my role is to work very closely in crisis situations with people. and often in the beginning with the more difficult patients I won't do a lot of work, walking with them to a doctor's appointment. going with them to certain things, getting them into the routine. when I have seen that they pretty much can handle it then I back off a little bit. I tend to work on a general basis with clients rather than specific. PSC

close? I try to stay just kind of in the middle. I don't get too close, you know. but then I let them know if they have a problem, then I am here, talk to them and everything is confidential. but if I see a client getting kind of close, then I say wait a minute, this is not appropriate. BVI

I'm close with the guests in the sense that I go places with them and we do things, and are friendly. but I keep it professional. I take them out to play ball, and I bring my daughter, and other staff bring their kids, and it's all very friendly. some guests love the kids, they don't want to play ball but they love to play catch. but when they want to come home with me, I tell them no. I define the limits, so they know what they can expect of me. it's helpful for them. PSW

Staff also were asked in interviews whether there were a lot of rules and regulations for clients in the shelter, and whether these rules and regulations were "OK." Most staff emphasized the importance of the shelter's rules and did not view these rules as excessive.

yes, we have a lot of rules and regulations. we have limit setting here. I think it is appropriate for the guests that we are dealing with, they need these rules and regulations. and some people tend to do better in a placement where they have structure. PSC

there is not a whole lot. most of them are pretty good balanced, they have their own chores to do. there is a few that complain but it is always the same people that complain about everything. basically they do it. I think the rules are fine.BVI

yes. a lot of rules and regulations. for 2fold reasons: we're out here and we are dealing with people with substance abuse and mental illness. and you know that their behavior can sometimes injure themselves or injure someone else. 2 because it's very hard to get someone who is addicted or someone who is mentally ill to respond to limiting rules and societal norms. and if the objective is to move people back into society and hopefully society expands and relaxes so that everyone is accepting, and we are living as a group and still ??? around and shutting off people, they need to know and understand rules, becuz rules will also be an integral part of society. and so that's the first thing people need to understand. BVI

Several respondents characterized the rules as weak or at least ineffectively applied; one recommended that rules about substance abuse be stricter.

not more [rules] than in other places. I would like to see a few more. I'd like to be able to kick people out if we need to. sometimes this is very good and we don't have that privilege so we get stuck with: you must not drink, and you must not do this to other people. and they do it anyway and what can you do about it? so I like to see staff having more power in terms of our decision making. there is several people right now that really would benefit from us saying: "good-bye. go to the streets. don't talk to us that way." PSC

we don't have a lot of ways to enforce the rules. we can send someone 1 hour out, 4 hours out. sometimes this is a deterrent for people who really don't want to spend the night out but it doesn't change behavior at all. it is not positive, it is negative. in terms of the drug and alcohol, we developed a policy about that, but even then we don't have leverage for people that are abusing alcohol. we can't put people out in the street. PSC

At least one respondent at each shelter felt that the rules for clients were somewhat excessive.

Yea, I think that there's always too many rules, you know, in a place that's this big. I mean not that there's much choice, because you really have to have quite a few rules in order to run a place this big. But uh, the downside of it is that I think that people are subjected to an awful lot of direction. BVI

people have more dignity here than in shelters where they have to stand in line. but even if they emotionally don't need a lot of space they shouldn't have people walk by when they undress, they shouldn't have to live in a place with mice. (there's a lot of mice.) the rules are made for the majority, and there are a lot of people that like to sleep late and they can't do that. a lot of rights are taken away, a lot of options are taken away. so I don't think it is a place for anybody to be, staff or guests. PSC

yeah, we have the Department of Mental Health rules as guidelines. and then we also have to follow the Shattuck [Hospital's] rules and restrictions. yeah, there is a lot asked from these people when they come in. it doesn't seem like much but there are a lot places they can't go. they can't go out after 6 o clock. they can't go out and smoke after 6 o clock. and that's because people will come in and they don't want people to see the shelter. a lot of restrictions. I think our rules are ok as far as the shelter goes. they are very basic. we don't ask a lot. I think what the Shattuck asks us is almost impossible. you know, to not let the guests outside after 3 o clock once they come here. or just go to certain designated areas to sit. I think the Shattuck is a little unreasonable. PSW

Perspectives on Work in the Shelter

Job Characteristics

Service activities at the shelters reflected a mix of responding to health and basic needs. About half of the staff helped guests daily with mental health problems and with food and beds. About one-third provided help daily with personal crises and substance abuse problems. Almost one-quarter of staff helped guests daily with physical health problems and financial benefits, while one in five helped with family problems, housing placement, job training and education. Just fourteen percent helped daily with AIDS prevention.

The most marked variation in staff activities between the three shelters was in help with substance abuse problems: almost half of Bay View Inn staff helped guests daily with drinking or drug problems, compared to one in five of the Parker Street West staff and just one in ten of the Parker Street Central staff. Parker Street West staff were distinctive in two respects: they helped guests with financial benefits more frequently than staff at the other two shelters, but none of the Parker Street West staff helped guests daily with job training and placement, education, or AIDS prevention--activities that about one in five of the staff at the other two shelters engaged in daily.

Help Guests with Following Types of Problems

(% Daily)

PSC PSW BVI Total

Mental Health Problems 56 33 50 49

Providing Food and Beds 54 50 44 49

Personal Crises 31 44 29 33

Drinking Problems 13 22 48 31

Drug Problems 12 22 42 27

Physical Health Problems 20 33 25 24

Financial Benefits 14 50 20 24

Family Problems 25 22 17 21

Housing Placement 21 29 12 19

Job Training/Placement 23 0 21 19

Education 21 0 20 18

AIDS Prevention 18 0 16 14

Staff comments during interviews summarize the programs at the three shelters. In general, the Bay View Inn offered the most programs for guests, while Parker Street Central and West relied more on CMHC-based day programs as the primary source of programs for guests. Each of the shelters had instituted a token economy system, although Parker West staff indicated that their token economy program had not yet been accepted by all staff and guests.

Parker Central's token economy system appeared to have motivated guests to take responsibility for chores and to prepare for more independent living. Occasionally staff walk with guests to movies or other activities in downtown Boston, and some counselors emphasized the value for shelter guests of their personal relations. Parker Central also offered health groups for men and women, a housing meeting, and a monthly community meeting, but staff indicated that few guests attended meetings regularly unless they were required to.

it's difficult to get all the guests involved and interested in groups because some just naturally don't do well in groups. and they won't participate in groups. because they are too paranoid. because they are afraid that they'll be challenged in a group and they'll fail. it's a real problem. so you can't expect everybody to come to a group unless you make it mandatory. PSC

He [a vocational counselor] had some things such as washing up headphones, stuff letters, things like that. couple of our guests got interested in that but it is just menial work to them. our guests have real trouble concentrating and focussing on a give task if it requires any kind of attention span. they just can't handle it. PSC

One staff member at Parker Central believed that too many guests lacked structured program opportunities during the day.

we don't have that many programs here. the programs are run outside of the shelter. it is not the shelter that is doing the program. a lot of the guests do not have day programs to go to. that's one of the biggest problems because the shelter is closed and they hang out in front of the shelter or in the lobby, and basically they need more structure. they need a place that has more structure or something for them to do because I don't think it is healthy for people just staying out there every day and just hanging around in front of the shelter with nothing to do. PSC

Bay View Inn emphasized structured group activities and required guests to participate in programs.

we have different groups. we have sex ed group, 12 step, we have aa group that comes in during the weekend. we have our community meetings. we have morning meetings every morning. we have activities committee, we have rules committee. if another client wants to take something to the rules committee if someone has done something that they don't agree with, that they get aggravated or whatever, then they can bring it to the rules committee. staff and guests are on the rules committee. we have art therapy group. we have softball, we have regular activities taking them to parks and things like that, outings. we have current event group.... we have during the day for the people that stay here, we have current events group, exercise group, budget group, those are the groups throughout the week. BVI

You can't just let them come in and out and let them drink and drug whenever they want, and expect to have any good results. If you think you're going to have some positive outcome. So we have very directive drug and alcohol treatment, very directive. But, we have hit a lot of clients and they want to stay and deal with it and so I think people are basically looking for help, and once they get into an environment where they feel safe, and then they have the help, they take it. That's what I see. BVI

Parker Street West staff noted limitations in their ability to offer programs for shelter guests.

what we offer the guests is their treatment programs where they go every day. most of them have day programs. they go there. what we offer the guests is from here, we offer them activities, that's about it. softball, basketball, golf, take them to movies and stuff. we find no interests in women's group, men's group, they are just not interested. we have tried to make them mandatory, "I don't want to go." we have a token economy and that is just filled with their basic hygiene needs. we don't have money for anything else, so they can get this, toothpaste, toothbrush. PSW

there is no services or programs here. they have to go their day program wherever. we have activities, but we have to go out because we really don't have anything here apart from the television. we have no place where people can relax. just the smoking room upstairs and that's a smoking room. PSW

One Parker West staff member indicated that their attempt to implement a token economy system had not yet succeeded.

[The token economy] started off really good. here it seems to be like the thrill is off and it is not that big deal any more. a lot of them come up, and they come up and don't even give their tokens when they open the store. a lot them don't care any more. I don't know maybe that's because a lot of the staff changed or enthusiasm of the staff is gone for it. PSW

Staff were also asked to classify their work in terms of actual activities. The most common activity was answering phones--reported five or more times per week by almost nine in ten respondents, followed by paperwork and keeping order--about three-quarters participated at least five times per week. Counseling and contacting agencies were common activities for over one-third of staff, while crisis management, housing search, training guests, assessment, training other staff and case consultation were common activities for about one-quarter of staff. The least frequent activities were being trained and meetings--both staff and inter-agency meetings, with only about five percent engaged in these activities five or more times per week.

There were some differences between shelters in the frequency of these activities. Staff at Bay View Inn were somewhat less likely to engage in counseling guests or contacting agencies, or in crisis management or training guests than were staff at the other two shelters. Staff at Parker Street West were most involved in crisis management, housing search, training and assessment and case consultation.

Frequency of Engaging in Work Activities

(% Five and More Times per Week)

PSC PSW BVI Total

Answering Phones 85 100 84 87

Paperwork 74 78 78 76

Keeping Order 68 89 74 74

Counseling/Therapy 59 57 26 43

Contacting Agencies 39 44 28 35

Crisis Management 33 43 19 28

Housing Search 22 38 24 26

Training Guests 27 38 14 23

Assessment 19 38 20 23

Training other Staff 12 57 19 22

Case Consultation 12 43 15 18

Receiving Training 17 0 0 6

Staff Meetings 5 0 8 6

Inter-Agency Meetings 12 0 0 5

Some of the most important work at the shelters involves the personal relationship established with counselors and clients. Although these relationships are not considered to be a particular "program," they can be of great value. A counselor at Parker Central described this work in some detail.

I come into work, I read the public log, see what's happened, see who is having a difficult time and who is not having a difficult time. who maybe I just need to say hi to or happy birthday. this is an important thing if someone has a birthday and you forget about it. it's important and I always remember that. I go through the dorms, talk with people, check and see how they are doing. PSC

Staff reported a relatively high level of autonomy on their jobs. Almost half reported that their job required them to make decisions on their job and to be creative "a lot." Many reported that their jobs were complex: between one-third and two-fifths said that their job required them to do a variety of things, to keep learning new things, and to use a high level of skill. Only 16 percent reported that their job required them to work very hard "a lot."

Staff feelings about these job requirements were fairly similar at Parker Street Central and the Bay View Inn. Parker Street West staff reported somewhat more job autonomy and were less likely to say that their job required them to work hard.

Job Requirements

(% "a lot")

PSC PSW BVI Total

To Make Decisions on Your Own 40 67 50 49

To be Creative 35 67 46 46

To do a Variety of Things 35 44 42 40

To Keep Learning New Things 30 33 39 35

High Level of Skill 20 38 37 31

To Work Hard 20 0 18 16

Two in five staff reported having a lot of say in shelter policies for specific clients, while one in five reported a lot of say in shelter staff policies and in shelter service policies. Parker Street West staff reported the most say in two of the three areas, while Bay View Inn staff reported the least influence in two of the three areas.

How Much Say in ...

(% a lot)

PSC PSW BVI Total

Policies for Specific Clients 47 44 32 39

Shelter Staff Policies 21 43 21 24

Service Policies 21 44 14 21

Comments from staff at Parker Central illustrate the opinions of those who felt they had much influence on the job and those who did not.

I think I have say in it. I think everybody here has say in it because if you find something not being done you got to say, look, I don't find this being done. so I think everybody has a little say in what goes on. PSC

I think I have as much say as anybody else in the shelter but there is the larger system that we have no control of. it looks like that I have a lot but I don't. even the person above has very little. not just the director, but the person above. PSC

One counselor at Parker Central suggested that counselors needed to have more influence on decisionmaking about clients, while a case manager at the Bay View Inn felt that case managers should have more influence on decisions about specific clients.

No, I don't have any say. I think the counselors should have more say because it is the counselors that have contact with the clients. a lot of the management style here, they delegate authority. so a lot of times they don't know anything about the client. it's the counselor letting them know who that person is and what the problem is of that person. there is really no one here but the counselors who have close contact with the clients here. PSC

should you have more say? I think it depends on what the situation is. with clients yes, because we are the case managers. as far as the programming and stuff goes, it's equal say amongst, you know, we, the case managers, and director and the assistant director and the nurses.BVI

Perceptions of overall influence on the job also varied among Bay View Inn's staff.

sure. we do. in staff meetings everybody's opinion, there is no right no wrong, everybody's opinion matters. sure, it counts.BVI

I can suggest. how far it goes I don't really know but I can suggest but I don't think that my word is the word at this time. there is a lot of people above me.BVI

staff is set here, in my own opinion, I don't know, I don't want to judge people it just seems and I have heard this from a few others that haven't chosen to participate as much that it's a little cliquey. BVI

A staff member at Parker West described an open, participatory environment.

yeah. in the general working of the shelter itself usually everyone whatever anyone that, all the staff, they have various meetings, staff meetings and everyone is open to all their ideas. and usually if it is feasible, different ideas are tried out. which is good. the staff that is here right now is very good about implementing things that they feel could be done with the client. or some staff will suggest this with this client might be better. and everyone is listening to it. PSW

Job Satisfaction

Overall, job satisfaction was high among shelter staff: almost nine in ten were very or somewhat satisfied with their job, three-quarters wanted to stay in their current profession and seven in ten would take their job over again if they were given the choice.

Responses to some other questions yielded more indications of dissatisfaction. Almost eight in ten reported conflicting demands at work often or sometimes, two-thirds reported that their workload was heavy, and almost half said they were "burned out." Just two in five said that the job lived up to their expectations "very much" and a similar percentage were likely to leave the job within the next year. One-third had been notified that they were to be laid off or were very worried that they would be notified.

Bay View Inn staff were most satisfied with their jobs, while Parker Street Central staff indicated the most dissatisfaction. Bay View Inn staff were most satisfied with their jobs overall (almost all staff were at least somewhat satisfied), most likely to want to take the job again and to report that it lived up to their expectations, and least likely to report conflicting work demands or feeling burned out. Parker Street West staff also reported relatively high levels of job satisfaction in many respects. Parker Street Central staff reported the lowest levels of overall job satisfaction, were least likely to want to take their job again or to stay in their current profession, were most worried about being laid off and most likely to plan to leave within the next year, and were least likely to recommend the job to friends or to find that the job lived up to their expectations.

Evaluation of Job

PSC PSW BVI Total

% Satisfied with Job 75 89 96 87

% Sometimes conflicting work demands 96 78 68 79

% Like to stay in current profession 70 89 74 75

% Decide to take job again 60 67 79 70

% Workload is heavy 60 72 70 65

% Strongly recommend job to friends 45 56 52 50

% Burned out 55 56 39 47

% Job very much up to expectations 32 38 54 44

% Likely to leave within next year 60 33 42 42

% Notified or very worried about layoff 50 22 22 32

When assessed in terms of specific job elements, satisfaction was reported most often in terms of the work itself and supervisors, with over two-thirds of staff also reporting satisfaction with their coworkers. About half were satisfied with their salary and about two in five were satisfied with promotion opportunities.

Bay View Inn staff reported the highest levels of satisfaction with each job element except for satisfaction with their supervisor (in terms of which their high level of satisfaction was exceeded slightly by Parker Street West staff). Levels of satisfaction with the work itself were similar between the three shelters, but Parker Central staff reported markedly lower levels of satisfaction with their coworkers, as well as with their supervisor.

Satisfaction with Job Elements

(% moderate and very satisfied)

PSC PSW BVI Total

Work 84 89 93 89

Supervisor 75 89 86 82

Coworkers 45 78 89 72

Salary 45 33 54 47

Promotion 32 25 48 39

Relations with people were most often mentioned in the interviews as the basis for satisfaction or dissatisfaction with the job. At Parker Central, several staff focused on relations with clients.

I am not satisfied with the job, I am satisfied with the people. I think it is too much politics involved with dmh and management. and they worry about the government and the mayor more than they worry about the clients. basically I am here for the clients. I am not satisfied with the job, I haven't gotten a raise in 3 years. I must say it is for the people that I am working with, it is not for money and not the job, it's the people that I care about. PSC

I think it is not very challenging at all. I think it is a real pain to work and there is a lot of staffing problems. I am not very satisfied. I think I do the best I can when I am here but I am rather not. I feel fed up, not burned out, fed up in terms of system stuff. and sometimes you are working really hard with a lot of guests and people sabotage it, they are using drugs and they are in denial. they expect things they feel they are entitled to without working. I know that's my own values but it is real hard if you are working hard someone sabotages it. or says he is going along with it and passive-aggressively doesn't. so I get fed up with the system and with the clients and I get fed up with the staff. that covers about all, doesn't it. PSC

A staff member at the Bay View Inn highlighted positive relations among staff as a source of satisfaction.

I very much like my job. I like the people I deal with, I like coming to work most of the time, and you know, I do enjoy being here. BVI

Many staff identified relations with clients as a key source of a sense of accomplishment at work.

yes, when people leave here and come back and say, I am doing good, that's a sense of accomplishment. and if they tell me, you have helped me out a lot or they call me. I have a couple of guests who call me from where they live now, just to check in with me to let me know how they are doing. and they call me up and tell the problems they have. PSC

yes. when you see a client first come in here, and he's very dirty and half of the time can't remember his name or your name. and then after a while, no matter what period of time it takes, he eventually works his way up with his hygiene skills, daily contact, is able to look you in the eye, and stuff like that going on. and then to see him move out and know that he is doing well, it's great. BVI

overall I really enjoy especially going out on activities. it is very good to go out and have a good time with these people. try to show them a good time, show them what's out there. the only problem I ever had here was with staff. the clients are great. BVI

Satisfaction with Services, the Shelter and the System

The distribution of satisfaction with shelter services was markedly different from the distribution of effort on shelter services (see table ). Providing food and beds elicited the most satisfaction--three-quarters of the staff were very satisfied. About half of the staff were very satisfied with the shelter's efforts to provide help with financial benefits, mental health services, AIDS prevention and housing placements. Help with physical health, personal crises, and substance abuse problems were rated as very satisfactory by about two in five shelter staff. One in five staff rated help with job training and family problems as very satisfactory, while only one in ten rated help with education this highly.

There was some inter-shelter variation in satisfaction with particular service efforts. Staff at Parker Street West tended to be less satisfied than staff at the other two shelters with the help provided for mental health problems, family problems and education; AIDS education seemed in particular to be neglected at Parker West. Staff at Parker Street Central were less satisfied than others with the help they provided with substance abuse problems and with job training, but they were somewhat more satisfied with mental health services and AIDS prevention at their shelter. Shelter efforts to provide help with substance abuse problems elicited the most satisfaction among Bay View Inn staff.

Satisfaction with Shelter Efforts in ..

(% very satisfied)

PSC PSW BVI Total

Providing Food and Beds 74 78 78 76

Financial Benefits 53 56 44 49

Mental Health Services 63 22 48 49

AIDS Prevention 67 11 48 48

Housing Placements 58 56 37 47

Physical Health Services 44 33 44 43

Personal Crises 37 33 48 42

Drinking Problems 16 44 52 38

Drug Problems 16 33 52 36

Job Training/Placement 12 22 28 22

Family Problems 28 11 18 20

Education 12 0 15 12

Bay View Inn staff explained in the interviews the bases of their satisfaction with substance abuse services.

the most effective, I think, our strongest point here at the program at this point is drug and alcohol rehabilitation. we're certainly beginning to become more behavioral. but I think our most effective point is our ability to somehow impact a mentally ill client who is a substance abuser to the point where they stop abusing. and I think that that is a very important thing. how we do that, and what it is that we have and infrastructure of this program, I can't figure out. I don't know if it's the people who we're working with, Andrew detox has certainly, I mean, it's just a blessing to have them above us because that really helps to have that connection with the detox and also some dmh beds are there. and having them, have a focus on dually diagnosed people. that's where I think our strong point is. BVI

I always think that the aa group or drug and alcohol groups are effective. people respond to it very well. I think the activities are effective because it gets people back there in a socializing way instead of them just staying here. I think the community meeting and the morning meetings are effective because it gives the guests a chance to speak out what there problems are, it gives them a chance to talk. BVI

There was less agreement on the effectiveness of sex education and other groups at Bay View.

I am not sure about the effectiveness about the sexual education group. people don't respond to that at all. they don't like that. maybe that's because they are embarrassed to talk about it. I think all the other groups are designed for a purpose and when they are serving this purpose whether for 5 or 40 people, I don't think it really makes a difference. if someone just gets something out of it.BVI

effective? I think community meetings are effective because they can discuss things that relate to the whole community. I think sex ed group is good. that helps them with aids, just education about safe sex and different sexually transmitted diseases. I guess pretty much everything. I think everything has an effect on them. I don't think we can all see it right away but it does have an effect mostly.BVI

Some Parker West staff felt that the shelter's reliance on programs offered outside of the shelter was effective, while others complained about the shelter's lack of the physical capacity to offer programs.

we have clients going to programs every day. they got a nice one upstairs. I think it is pretty good. it's part of the hospital. it's pretty good. they are pretty active up there. they go on outings. they go to events. they move and do things. and then we have mass mental and then we have fuller and transition in ???, they are pretty active. nobody has complained. the clients go, they do their things and they come back. and if it is a bad day, somebody will say something. but very seldom we have that. I think the programs are pretty good. PSW

I am satisfied. It is just the condition. you could do so much more. but given the place we are at, it is very, very difficult. but the guests are very compliant. it is just even cooking, even if you want to teach somebody how to do their laundry you have to go to the laundromat. and it is just like for somebody to move into their own apartment there are so much things he needs to know, housekeeping, and it is hard and we should facilitate that. PSW

Over two-thirds of the shelter staff were proud of being a part of their shelter, believed that staff at the shelter got along well and thought that staff with college degrees see things in the same way as other staff. About half found that their personal values and the shelter's values were similar.

Bay View Inn staff were most likely to be proud of their shelter and to report that staff get along well; they were as likely to view their personal values and the shelter's values as similar as staff at Parker West, but were least likely to agree that staff with college degrees see things the same as those without college degrees. Parker Street Central staff were least likely to agree with the positive statements about their shelter, although they were more likely than those at Bay View Inn to agree that college degreed staff see things similar to other staff.

Feelings about the Shelter

(% strongly agree and agree)

PSC PSW BVI Total

Proud of Being Part of Shelter 55 78 79 70

Staff Get Along Well 40 56 89 67

Degreed Staff see Things Same 75 89 54 67

Personal and Shelter Values Similar 35 50 50 45

Relations among staff elicited numerous, lengthy comments from staff at Parker Central--and almost all of these comments pointed to inter-staff conflict. The conflict was characterized by some as having a racial basis--black staff versus white staff, by others as having a shift basis--evening staff versus day staff, and some mentioned an occupational basis--professional staff versus paraprofessional staff. Of course, each of these variables is interrelated (evening staff tended to be black paraprofessionals). Nonetheless, several staff remarked that all staff members were concerned with client welfare.

professional staff? I think they should have more input if they have contact with the clients. but the nurses and the professional staff here do not spend a lot of time with the clients. they just give them medication out. and there is more than giving medication out. if you want to get to know a person you have to talk to him and not just giving meds and thinking you know a person. I think they should have more input if they are making more contact with them, that's fine but that's not the case. PSC

you know, the nurses are here, and the clinicians are here, and the mental health workers are definitely at the bottom. and that's a problem. you can't create that hierarchy in terms of looking at this sort of setting. I think it has to be across the board. PSC

in this system, the majority of the people who are working in this system are, when it comes to color, I think they are afraid of African American black men. I can seen that. when they see a black client, I just can sense the fear that they have, that people have instead of trying to understand him. I think there is too much of it. PSC

we are somewhat a dysfunctional family but not totally. so we are in recovery. the recovery, I think, is from starting to have staff meetings where we are talking about issues and not talking about operational stuff. you know, this is how it operates, we need to do this, x, y, and z needs to be done. and it's more, how do you feel about working here, and what does it feel like for you if somebody says something to you in that way. and how would you want that person to speak with you. and that's really good for people to talk about. some of this is not getting resolved but I think it's good to at least have that event where people can start to talk. that's really good. because doing this work, I think, we need to support each other because it is really taxing work to do. we have to have a support system for each other. PSC

By contrast, comments about relations among Bay View Inn staff were very positive.

in general, yeah. I think staff get along here better then anywhere else I have worked. I don't know why that is but I think that they don't, everybody has their little conflicts but they don't usually tend to let them stretch out here. BVI

Yea, we have a very diverse staff. The morning shift is a little older, mostly you know working mothers or people all from this sort of general area who grew up together, and the 3 to 11 shift is mostly college people younger staff, all that know each other, live together. A lot of our staff are roommates, a lot of our staff are husband and wife, a lot of our staff are brother and sister, so we have a lot of incestuous, you know staff people, all related in some way. So, the staff are very family related not only because they're close but they are relatives a good part of the time. So the staff are, the staff are very good. We are very lucky to have who we have out here. BVI

Parker West staff expressed relatively positive feelings about staff relations.

you know you have a little pulling this way and pulling that way and this and that. you know you have that on every job but I think we get along. I do. some folks are harder to please than others. when things are going right it is good. PSW

Satisfaction with the shelter overall was very high among staff--eight in ten staff were very satisfied or at least more satisfied than dissatisfied. Two-thirds were satisfied with the NIMH Project and almost six in ten were satisfied with the services provided to their shelter by the local Community Mental Health Centers; few reported frequent problems in getting services for shelter guests from agencies outside of mental health.

Overall shelter satisfaction was much higher among Bay View Inn staff than among other staff at the other two shelters, while satisfaction with the NIMH project was markedly lower. Levels of satisfaction with the local CMHCs and with other outside agencies were similar between the three shelters (each of which had to work with the same CMHCs and other service providers).

Feelings about Service Providers

PSC PSW BVI Total

Satisfied with Shelter 65 62 96 80

Satisfied with NIMH Project 80 86 50 67

Satisfied with CMHC 55 57 59 57

Often have Problems w/Other Agencies 15 14 10 13

One of the most common complaints at Parker Central was the inability of the shelter to refuse to admit or to expel clients who staff deemed inappropriate to the shelter.

right now we have this patient that is huge and assaultive and is inpatient 6 times. he has been inpatient since he came to us. I don't think he is appropriate for us. and we don't have the power to say no. ...I feel like that we are a dumping ground in some ways. and that we are in dangerous situations that we have no power over. PSC

The poor quality of relations among people at the shelter and shelter "politics" also elicited complaints.

no, I am not satisfied with how the shelter is run. I think it can run better than it is being run. I think if they would get rid of the politics, people would be under less pressure and would do a better job. I think management worry more about the politics that is involved in the job and satisfying the government and the mayor. PSC

respect is number 1. if people respect each other we would do an excellent job. but all the politics that are involved, it is always dirty. there are a lot of things that are going on here that I don't like. PSC

Comments at Bay View emphasized the quality of relations among staff, but there was a dissenting voice.

Oh, I'm very satisfied with the way that the shelter's run. Again, I think we have a very good team here, we really complement each other on the way things, on the way things happen. You know. Especially our administrative team is very good and like I said the counselors are you know a very good...we have a nice group of people out here. BVI

I am very satisfied with working with this population, it's great, they are really good people but they could do a lot better for themselves. the only thing I would be unsatisfied with is the way this particular organization is run. I would appreciate a place that is more dedicated to improving itself and listening to something that is maybe a little different from what they believe. but I don't see it now, I haven't seen changes. BVI

The absence of a fulltime shelter director at Parker West appeared to one staff member to have caused problems.

some people just don't have it I guess. sometimes people need to be pushed. if they are left alone they'll do nothing. but if you have a director telling them, checking on them every now and then. then they could get a lot of work done. I have seen that happen when we had directors that checked on people. and then when the director was gone, they slob right back into the way of not doing anything. PSW

The CMHCs and regular DMH case managers were viewed favorably, although there had been some problems with some CMHCs (a long waiting list at one, problems in getting medication for clients at another, at lack of housing opportunities at another) and, at times, with specific casemanagers. Several staff emphasized the importance of collaboration with DMH case managers and the ability of shelter staff to relieve the DMH case managers of some of their responsibilities for clients.

a lot them are really effective in what they do. and some of our clients are really connected to their case managers, 5-6 years worth of almost therapy. the case managers represents an expectation for this person even if it is just in maintaining a relationship. Even if it is just an appointment that they have to keep. or if not, they have to call. PSC

Staff did perceive substantial variation in the quality of DMH case managers: "There are different people; some do good, some don't"; but it also was suggested that this variation in casemanager-shelter guest relations was due in part to the differing levels of interest among guests in keeping in touch with their case manager. System fragmentation and recent cutbacks also were identified as a sources of problems.

the one problem I have with the whole system is there is too many people doing the same thing with the one client. that doesn't mean that that doesn't always support. but if you have a client that has to go out all the way to Bay Cove to meet with his case manager every week to chitchat and then come all the way back to meet with the mental health worker to chitchat and then he goes to see the therapist to chitchat and then go up to see a psychiatrist to get medication. I personally don't feel that that's, it may by and large be a waste of money. PSC

services right now are crazy. I spent all day yesterday trying to get in touch with a cm. and she ended up finally telling me that she was laid off, and that she had 2 weeks to go. so services right now are absolutely crazy. BVI

CMHCs also were seen to provide varying levels of service to the shelter guests, perhaps, one mental health worker suggested, because of the variation in caseloads at the centers. One respondent explained in detail the source of problems with some CMHCs..

Well, basically they're pretty good, given the fact that we deal with all of them in the greater metropolitan area. Then again the case managers do most of that interfacing, between the mental health centers and here. It's very good to have a good relationship with them, because they have a lot of services that they can provide for clients, and also the inpatient units are in the mental health centers. Some are better than others, and I would say that one or two of the mental health centers are terrible; they were terrible before the budget cuts and they're worse now. So, you know, but basically I would still say in general we get along ok with them. They're very happy to have this place, and to you know have a place where people can come. BVI

[how did the problems with those particular mental health centers affect services here?]

They have a tendency to dump their people out here and not do anything for them. And say, well even though they know damn well that this is a transitional treatment unit--people can't stay here forever, they just have this idea that, well, they're in a place, they're housed, and we have people on our inpatient units, and we're going to put them in housing first. And consequently our people never come up on the housing list, but they're housed already. And this is a common problem. BVI

[what do the other mental health centers do compared to the ones who leave their clients out here]

Well, they're actively engaged with their clients; they have very good case managers that are committed to their clients; they respond instantly when we have a concern about somebody's psychological state; uh, they don't give us a big long tough time as though we just studied Psychology 101 last week and we don't know what we're talking about--I mean we've been doing this work five years; give me a break, right? I don't need to hear this crap from these people, you know, when they're saying so and so doesn't seem that bad, and we know damn well different, right? I would say active engagement with the client is the critical point, though. And once, when you get the people in Bay View are actively engaged and if you get an active engagement in the mental health department, in the mental health center, then you got a, then the client is going on the good road. You know, they're going to get help, for the most part. And that's the difference. BVI

Changes in the Shelter

Some changes had occurred in the shelters within the previous year. Management personnel had changed at the two Parker Street shelters, and each shelter had attempted to implement the token economy program; some staff felt that clients entering the shelter recently were more disturbed and attributed this to the statewide cutbacks in mental health services and hospital capacities. New rules were implemented at Parker Central about storing personal belongings at the shelter--"these are big changes for some of these people." PSC

A mental health worker at Parker Central reported a change in the basic shelter philosophy, from a more institutional approach to transitional support.

one thing we have changed in the shelter is the shelter was modeled after an inpatient unit. we are not an inpatient unit. we are supposed to be a 6-month transitional shelter. that means that they come in for 6 months and they get services, they learn how to do, we try to teach them certain skills so that when they get out into the house with other residents they know how to behave. so in the beginning of the shelter the staff was treating the guests as in an inpatient unit where we would be doing the laundry, cleaning the tables, taking care of trash. and it took me about 6 months to convince the rest of the staff that this is ridiculous. all these guests should be doing their own laundry, doing the towels, doing the laundry, the tables, watering the plants, all that kind of stuff. and as far as far I was concerned..., mental illness does not exempt you from doing certain things. you may hear voices as you wiping down the table but you can still wipe down a table. so we decided as a staff all of the guests would have a chore to do once a week on a given day.and they would have to follow through or they would have to stay out of the shelter until 11 o clock at night. we didn't want to kick them out from the shelter to stay some place else like in pine street. but we wanted to make it uncomfortable enough that they say I don't want to stay out till 11 o clock, I will do my chore. PSC

Most comments about change were directed at the effect of recent budget cuts. Guests who had had long-term relationships with clinicians suffered when these clinicians were laid off. In addition, CMHC-based case managers functioned as representative payees for some guests, so cutbacks in case management staff resulted in some guests receiving their SSI checks at the shelter: "They buy 50 scratch tickets when they get their check and spend their money like crazy."

clients? I think some of the clients that are coming in this year need more care and services, and I think that is due to outside cuts and stuff. i'd say within the last couple of months, there is more change because the clients don't have the services or the day programs to go to, so. I think the clients will be different coming in here because of what they have gotten outside. i have experienced that very much so.BVI

Over the long run, however, Bay View Inn seemed to have become much more effecstive.

oh yeah, a lot. the clients are more involved with their own treatment planning now. there's a lot more staff, I think, now than there was when I first started. the computer's new. there is more client involvement in everything right down to hiring, even now there is like a board where some employees coming in, they need to go before the clients too. and then they go before community meeting. so they are really involved. things have changed. BVI

Well, I think we've had less and less turnover. And part of that is because the program is well defined and well developed and staff have a lot to say about how this program is run. That's one part of it. The second thing is the current issue of the budget, of course. There's no jobs out there so people are not moving on. BVI

when I first came here there is nothing to do. you wrote progress notes on client's involvements and instances. now there is a lot of things to do. a lot has to do with the pstp which replaced the old isp. it's a lot more ???, I think it is great. personalized service treatment plan. I think they are good. they define personal goals that need to be worked on, what they need to do to get where they want to be. and there is the staff lounge now which was built was the leftovers from the funds from last year. BVI

I think there is a lot more hard working atmosphere here now.it has gotten better but it was so far gone.BVI

Staff Backgrounds

Many staff had had specific training or experience in human services. Three quarters had worked previously in human services and eight in ten had had some special training. Staff had worked on average more than two years at the shelter and in their current position. Somewhat more than half of the staff earned less than 1250 dollars per month, while just over one quarter worked in a professional job classification.

Parker Street Central staff had worked in their current position for the longest time--an average of more than three years, and were most likely to have had special training for the job. Bay View Inn staff were least likely to have had previous work experience in the human servcies and also were less well paid as a group. In other respects, the job situation of staff was comparable across the three shelters.

Work Experience and Training

PSC PSW BVI Total

Previous Human Service Experience 75 100 64 74

Any Special Training 85 78 79 81

Years since Started Position (mean) 3.33 1.99 1.29 2.14

Years since Started at this Shelter 2.75 3.28 2.34 2.64

Monthly income less than $1250 45 33 66 57

Professional job classification 25 33 29 28

Staff social situations were diverse. Four in ten had a college degree, and about half of these had majored in human services (including some with a graduate degree). About one-third were in their twenties, about one-third were married or living together and over two-thirds had no children; one-third were black (no other minority groups were represented among the respondents).

Parker Street Central staff were most likely to have a college degree and to have majored in a human service field in college, while Parker Street West staff were the oldest and also least likely to have a college degree. Staff at Parker Central also were least likely to be black. Staff at Bay View Inn were the youngest and the least likely to be married.

Employee Characteristics

(Percents)

PSC PSW BVI Total

College degree 59 17 36 42

Human Service Major in College 60 44 43 49

Age 20-29 25 11 48 34

Married, living together 26 33 33 31

No children 68 56 78 71

Black 24 44 30 30

RECOMMENDATIONS

Recommendations by Staff

1. We need to have a housing contract and a general treatment contract. I think there needs to be a few more consequences to some folks who are manipulative.

2. I just think strongly that the clients should be paying, that would be the only change that I would say. I think it is very important that they do pay. I don't care whether the money goes to them or to the state but it doesn't make any difference. I think it is very important in this transition from the shelter into their own place.BVI

3. I think that the work schedules could vary.

4. I think we could try and hopefully get more staff. that's really important. I think we do need more staff here. I think that that would be really essential.

5. The degree of cleanliness could improve in terms of the overall environment [especially air quality]. it looks nicer. but we are still a basket ball court, still in the basement. I think that we need to be some place else. I think that's important. I think that we need to be some place that can afford people a shelter environment maybe more like a group home setting in a building that would be in a more normal neighborhood. I think that we don't have for people as much privacy as we think we do, 50 people in a basketball court, it's kind of hard. PSC

6. I would like to see the clients that come in here, before they come here, get a complete medical as well as psychological workup. I think sometimes the medical is overlooked. because this people are mentally ill and this is a shelter for the mentally ill homeless. and I would like to see a complete physical. giving them all the shots and blood work if necessary. because we deal with people we don't know a whole lot about. and I think we should know something about them medically, if there is something wrong before they are here for a period of 2, 3 months before they are telling someone. and if it is something contagious, it is already too late. that's never been done. and I don't know how hard it would be to have it down. I suppose something that we set up as a policy, that it would have to be done. but I think that's important. especially today with the aids. BVI

7. Give them some constructive things to do with their time, not just watching tv all the time and smoking. there can be a lot of policies to have this place work better. managing their own store, ???, transport each other with the van, I don't know how with the insurance policy they could do stay. they can the census, they know each other, they don't need the staff to do that. they can serve each other food. they can do most everything that we do. I think we should be in a supervising position where we can take more our time to help them otherwise than doing these menial jobs. it would free us up. BVI

8. one other thing is when they have money left over from their budget they should put it back into the program. they have some terrible furniture and get some nice stuff they would care for. if it is junk basically who cares. instead they created this place downstairs for us to sit around. this in unnecessary. BVI

9. more staffing, ...all staff act in concert in terms of what they're doing, and not doing. but we haven't transcended the divisions between shifts. if had more staffing, would spend time getting people together. you can really do this, to the point that everybody really feels great about coming to work. PSW

10. [Some staff] need to hear that no one is indispensable. you can be replaced in any time, you are not that important if you are going to complain all the time, if you are not willing to work with guests. if you are not willing to sit with your client once a week, you are not that important to the shelter. PSC

11. Eliminate staff that do not want to work. some are so lazy and should not be here. be cautious whom to hire. oversee staff. also, staff need more free time, such as mental health days, just time away to relax. PSW

Research-Based Recommendations

1. Formulate a clear service philosophy for each shelter and publicize this philosophy through bulletins and staff meetings. The philosophy could be developed in staff meetings.

2. Plan a discussion for a staff meeting about the bases of homelessness. Bring in an expert to present some facts and to facilitate the discussion. Encourage an understanding of different viewpoints and explore the implications of relationship between attributions of responsibility and shelter philosophy.

3. Evaluate the differences between guests at Bay View Inn and the two Parker Street shelters in order to assess the validity of differential expectations among their staff of the readiness of guests for independent living.

4. Staff favored strongly charging guests for the use of the shelter. A decision should be made about this proposal and its rationale communicated clearly to all staff.

5. Shelter rules should be a regular topic of discussion at staff meetings. Frequent review of the experiences of staff with enforcing particular rules will help to refine rules and achieve more consensus on their appropriateness.

6. Review staffing and job descriptions at each shelter to ensure that all necessary services are available to shelter guests.

7. Help staff to share experiences with staff at other shelters. For example, Parker West staff reported that their token economy system was not functioning effectively, while Parker Central staff reported that their's was. A Parker Central representative might help to explain to Parker West staff how they overcame obstacles to program implementation. Bay View Inn required participation in programs, while Parker Central staff complained about low rates of program participation. Some comparison of these experiences would help to formulate a consistent and more effective approach.

8. The differing work activity mix at each shelter should be reviewed to determine whether any changes are advisable. For example, the lower level of reported staff involvement in contacting agencies at the Bay View Inn may indicate a need for more efforts to engage guests with other service providers.

9. Bay View Inn staff were markedly more satisfied with their jobs than staff at the other two shelters. Visits to the Bay View Inn by directors of the other shelters may help to stimulate beneficial changes in management approach. At Parker Central, poor relations with coworkers seemed to be the key element in job dissatisfaction. Special efforts to improve this critical aspect of the job experience are needed.

10. Different programs were rated as most effective by staff in different shelters. Sharing program models between shelters may help to equalize performance levels. In particular, staff ratings of the effectiveness of AIDS prevention, mental health services and substance abuse services were markedly higher at one shelter.

11. Few staff rated as effective their shelter's efforts in job training, education, or help with family problems. These are areas where new programs may be useful.

12. The poor relations among many staff at Parker Central needs attention. This is a source of dissatisfaction for many staff at Central. Since current efforts seem not to have resolved the tensions, an outside consultant may help develop a new approach to lessening the tension.