Methods: The study occurred at a homeless services center (HSC) in a large metropolitan region of the southcentral U.S. The HSC serves typically serves 85% of the people experiencing homelessness locally each year (approximately 6,700 people). We recruited a purposive sample of case managers (n=17) to participate in one of two different focus groups. Transcriptions of recordings were analyzed using Dedoose, a qualitative analysis software, using conventional content analysis procedures (Hsieh & Shannon, 2005).
Results: We organized results around: workplace environment, secondary traumatic stress (STS), and influences on client rapport. Case managers reported that workplace norms contributed to a general workplace culture of disconnection, competition, confusion, and individualism. Furthermore, they reported absorbing stress and trauma from their clients that spilled over from the work environment, affecting their personal lives, styles of coping, interpersonal relationships, and their perceptions of clients. Finally, case managers tended to describe their skills in terms of rapport-development, rather than simply linking clients with housing and other resources; ultimately, they viewed relationship- and trust-building as the primary focus of their work. As one case manager explained, “When I make [clients] feel as if what they want matters, then it's easy for me to get them going, to continue the process.”
Conclusions and Implications: Results indicate case managers working with individuals experiencing homelessness are vulnerable to both work-related stress and STS. Moreover, work-related stress and STS are affected by the workplace environment, and, stress negatively influences the rapport development process between case managers and clients. Adjustments to the workplace environment—in terms of culture and norms, internal process refinement, and expectations of staff—could lead to a less-stressed case management workforce, and higher-quality service delivery, and ultimately perhaps, faster time to housing, for people experiencing homelessness. One approach to enhancing the overall workplace environment is for administrators to clearly define the general philosophy of case management, and to support this philosophy with thoughtfully articulated policies and procedures and robust case manager on-boarding (Gaboardi et al., 2019). Core to implementing effective policies and processes is the consideration of caseload size and case manager communication, as well as opportunities for professional development through evidence-based trainings and trauma-informed approaches. Finally, supervision can be a useful approach to build both formal and informal supports enabling case managers to develop positive relationships with their peers, while allowing administrators to reaffirm organizational values, approaches, and philosophies.