I Have My Own Lease – Why the Service Plan Again? Perspectives on Service Planning in Supportive Housing

Background and Purpose: Person-centered care is now considered central to the delivery of quality behavioral and integrated health services (DHHS, 2005; President’s New Freedom Commission, 2003). Operationalization of these principles into practice standards for behavioral health providers has challenged the field. One emerging evidence-based practice, person-centered care planning (PCCP), has provided a set of manualized, recovery-oriented practices targeting the service planning process. PCCP can be implemented across an array of settings, including supportive housing, a growing service modality within behavioral health services. Research has remained limited on integrating PCCP in supportive housing settings that combine permanent housing and services for people with lived experience of mental illnesses. This study explored multiple stakeholder perspectives of implementing PCCP in single-site supportive housing programs serving people with lived experience of mental illnesses.

Methods: Multiple stakeholders (N=57) were recruited to participate in eight focus groups including four with tenants, two with service coordinators, one with supervisors and one with leadership. Eligibility criteria included living or working in the four supportive housing programs purposively sampled from a community based organization serving 1,500 people annually. Their experiences with service planning and implementing PCCP were explored. An inductive thematic analysis of all transcripts (Charmaz, 2006) combined with a conceptual matrix (Miles, Huberman & Saldana, 2014) and strategies for rigor (Padgett, 2008) yielded themes across and within the multiple stakeholder focus groups.

Results: Three themes emerged: the service plan functioned as an institutional reminder, a one size fits all service planning process, and rules and regulations surrounding service planning. Within each theme are perspectives from all stakeholder groups. 1) An Institutional Reminder. Service planning experiences elicited negative emotions and served to remind people of past experiences in institutional settings and the institutional elements of their current supportive housing program. 2) One Size Fits All Service Planning. Despite an organizational vision and culture consistent with PCCP’s principle of flexible, individualized services, quality assurance tools in the planning process were perceived by providers and tenants as required and rigid to others’ interests beyond their own. 3) Rules and Regulations. Reconciling funder requirements (e.g., required completion dates) while at the same time tailoring services to tenants’ particular situations challenged providers.

Conclusions and Implications: Funder expectations for the regular completion of service plans with all people living in a supportive housing program presented challenges to PCCP enactment. Organizational interventions to ensure consistent quality standards of PCCP across providers also may have contributed ironically to undermine the tenant and provider collaboration and individualized approach to people’s recovery. Even in a recovery-oriented organization, these findings suggest service planning in supportive housing has limitations in responding to each tenant’s iterative recovery process. Further, in this context where tenants can make their permanent home, tenants and providers questioned the very presence of ongoing service planning activities as problematic and inconsistent with PCCP principles. However, tenant-provider working relationships predicated on mutual respect and esteem overcame some of the limitations of the service planning process by allowing providers to attend to each person’s unique recovery path.