The Experience of Social Service Provision to Older Adults
with Schizophrenia in Housing ProgramsLydia P. Ogden, PhDAssistant Professor Lehman College, City University of New York
Citation:Ogden LP (2013) The Experience of Social Service Provision to Older Adults with Schizophrenia in
Housing Programs. International Journal of
Psychosocial Rehabilitation. Vol 18(1) 83-93
Lydia P. Ogden
Social Work Department
250 Bedford Park Boulevard, Bronx, NY
article reports on themes generated through phenomenological analysis
of semi-structured interviews with seven social service providers
experienced in working with older adults with schizophrenia in housing
programs. Their services assure housing stability, however attributes
of their work experience may affect implementation of effective
services. Understanding of their work experience can develop and
improve social service provision. Findings identify three essential
themes: Providers conceptualize older adults with schizophrenia as
“survivors;” providers saw these survivors aging into yet further
hardships; providers engaged in a parallel process of struggling and
coping with their work with these survivors. Discussion of the themes
is presented with consideration of practice and policy implications.
Keywords: Burnout; older adults; schizophrenia; phenomenology; service delivery issues
Many older adults with schizophrenia live in
community-based residences where on-site social services are provided. Housing
is a critical environmental and social factor, contributing to the health and
wellbeing of older adults (Cohen, Mulroy, Tull, Bloom & Karnas, 2007).
Effective services shape the housing environment and its outcomes for older
adults (Cohen et al., 2007). This study is set in the context of two types of
community-based residences: group homes and supportive housing. Group homes are
typically small residential facilities ideally designed to simulate family
life, offering medication management and 24-hour staff supervision, with staff
in control of the day-to-day operations of the facilities (Semmelhack, Ende,
Gluzerman, Farrell, Hazell & Schultz, 2010). Supportive housing models with
on-site social services typically provide each tenant with a permanent lease,
simulating independent apartment living, but with the addition of on-site
social service staff. It is estimated that between 33-50% of supportive housing
programs nationally are populated by older adults, the majority of whom have
psychiatric disorders (Corporation for Supportive Housing [CSH] & Hearth,
Inc. [Hearth], 2011).
Group homes have little regulation and few guidelines
(Semmelhack, et al., 2010) with wide
variation in services and organizational structures (Eckert, Carder, Morgan,
Frankowski & Roth, 2009). Similarly, CSH & Hearth (2011) describe broad
services needed by older adults in supportive housing,
ranging from assistance in navigating systems and accessing benefits, to
assistance with activities of daily living, 24-hour crisis assistance, and
physical and mental health care. The U.S. Department
of Housing and Urban Development [HUD] practice guide to developing social
services in supportive housing programs outlines similar guidelines, with the
addition of involving residents in the community and activities, and helping
with issues related to death and dying, with a mandate to ensure that the
residents receive all the services they need (Hannigan & Wagner, 2003). In
a separate HUD training curriculum for supportive-housing case managers, the
broadness of the role is encapsulated by the phrase, “Case Managers do Whatever
It Takes (W.I.T!)” (Center for Urban Community Services [CUCS], 2011; p.8) and
the explanation that, “the role of the Case Manager is to help hold all the
systems in place that help the tenant to function in the community” (CUCS; p.8).
“Doing whatever it takes” may be a greater challenge in
service provision with older adults with schizophrenia, due to their
psychiatric, medical and social functioning issues. The challenges
with the ongoing presence of symptoms of schizophrenia are compounded
life by high rates of medical comorbidities (Parks et al., 2006) and
isolation (Jeste & Nasrallah, 2003), at greater rates and severity
older adults in the general population. Indeed, the cumulative outcome
having lived through adulthood with schizophrenia and its associated
is an average lifespan 25 years less than that of adults in the general
population (Parks et al., 2006). Adding to the challenge, little
available to guide direct social service provision that seeks to
disparities in mental health, health, social functioning, and
longevity: Less than 2% of the research on schizophrenia focuses on
and fewer than 10% of published studies on schizophrenia include older
(Jeste & Nasrallah, 2003). Research specifically
focused on social service interventions with older people with
remains even more scarce, and to date none have addressed their
housing-based needs (Cohen et al., 2009; Cummings & Kropf, 2011).
Perspectives of social workers in housing programs for
the mentally ill have been examined to assess the adequacy of help provided
(Fleury, et al., 2010) and to understand their perspectives on the relationship
between housing and treatment of psychiatric illness and substance abuse
disorders across housing models (Henwood, Stanhope & Padgett, 2011).
However the daily lived experience of engaging in such work has not been explored.
The work experience with highly vulnerable populations, such as older adults
with schizophrenia, is important to understand. It contributes to the
development of a workplace climate that can support or impede service delivery
(Glisson, 2007; Glisson & Green, 2006).
Psychological climate amongst employees, defined in the
literature as the employees’ perception of the work environment on their own
well-being, has been demonstrated to affect service quality and outcomes across
service settings (Glisson, 2007; Glisson & Green, 2006; Larrison,
Schoppelrey, Hadley-Ives & Ackerson, 2008). The social service providers in
the housing programs identified above spend their days side-by-side with the
residents, thus co-creating environments wherein these older adults may
age-in-place, which is the preference of most older adults (Alley, Liebeg,
Pynoos, Banerjee & Choi, 2008; Cohen et al., 2007) and a goal of supportive
housing (Hanrihan & Wagner, 2003) and group homes (Eckert et al., 2009).
This study uses hermeneutic phenomenological methods to analyze
semi-structured interviews of on-site social service providers who work with older
adults with schizophrenia, with the purpose of understanding their workplace
experience that contributes to climate development and service effectiveness
(Glisson, 2007; Glisson & Green, 2006; Larrison, et al., 2008). An
understanding of the work experience with this population across on-site
housing settings may therefore be used to inform policies that contribute to work-place
improvements that, in turn, may improve the services rendered (Glisson, 2007).
Hermeneutic phenomenological methodology condenses the experiences
of persons with a specific phenomenon to a description of the experience’s essential
qualities, with the aim of describing what participants have in common as they
experience the phenomenon (Caelli, 2001). The goal of using phenomenological
methodology is to “humanize” institutions in order to help them function better
through the production of “action sensitive knowledge” (van Manen, 1990,
p.21). Ideally suited for the purpose of
this study, an understanding of the essential qualities of the experience of on-site
housing social service provision to older adults with schizophrenia may be used
as such “action sensitive knowledge” to inform improvements to humanize the
workplace climate and effective service delivery.
This study presents findings from the inductive analyses of semi-structured
interviews with on-site housing social service providers about their experience
working with older adults with schizophrenia in the housing setting. Inclusion
criteria for participants were: Employment
in a housing program by a social service agency either at the present time or
within the past five years; provision or supervision of case management
services for clients of that program, either at the present time or within the
past five years; and a minimum of eight months of experience. Exclusion
criteria were: Employment in a housing program that did not have on-site
services; and employment in a housing program that did not serve older adults
with schizophrenia. “Housing program” was defined in this study as group homes
and/or permanent on-site supported housing for persons who had previously been
homeless. “Older adult with schizophrenia” was defined as having been
documented by the housing programs as having a documented diagnosis of any type
of schizophrenia and being aged 55 and older.
recruited using purposive sampling strategies appropriate for phenomenological
studies that seek thick description from sources knowledgeable about the lived
phenomenon (Patton, 1990). Key informants known to the author through
professional connections, and who were likely to identify other information
rich participants, were contacted and asked if they would like to participate
and/or suggest potential participants for the author to interview. The
definitions of “housing program” and “older adult with schizophrenia” were
provided at that point of contact and also prior to each participant interview.
For the sake of simplicity, and to use the language of the study participants,
the older adults with schizophrenia will be referred to as the “clients” in the
results and discussion section; the on-site housing social service providers
will be termed the “providers.” Informed consent was obtained from each
participant. IRB approval was obtained prior to the commencement of recruitment;
informed consent was provided by participants prior to the interview.
I conducted seven in-depth
interviews with seven participants; follow-up contact was made with four of the
participants for the purpose of member-checking and strengthening the analysis.
This sample size is consistent with the recommendations for sample sizes for
phenomenological studies, which have a suggested range of 5-25 to discern the
essence of an experience (Creswell, 2007). In phenomenological studies data
saturation is critical to provide depth of understanding: the recruitment
strategy and the highly specified definition of providers, their setting and
their population, focused the inquiry in order to promote saturation.
experience in housing programs with older adults with schizophrenia that ranged
from 2 to 7.5 years, with an average of 4.86 years and a median of 6 years. For
education, four had master in social work degrees; two had bachelor degrees in
related fields; one had an associate degree in human service. Two identified
their race as Latina or Hispanic and five identified their race as White. All
but one participant were female.
In this study, the in-depth semi-structured interviews
ranged from 40-90 minutes in length and was divided into two sections: The
first part asked the participant to describe a specific experience that
exemplified his or her work with this population and the second part asked the participants
to reflect upon how they thought and felt about the experience. Questions posed
in the first part of each interview included: “Can you give me a specific example
of the work you have done in one case? Who else was in their lives? In addition
to the challenges, would you say this group of clients had any shared set of
strengths?” Questions posed in the second part of each interview included: “How
do you think those clients saw your role in their lives? What was the working
with these clients like for you?”
I identified themes that emerged in the earliest
interviews and asked subsequent participants questions relevant to these
themes, focused on identifying and developing in-depth understanding of the essential
themes. If the questioning around a particular theme yielded thick description,
the line of questioning was continued and developed in each further interview. Follow-up
contact was made to confirm and deepen the analysis. Data were collected by audio
recording and note-taking.
To analyze the
interview data using a hermeneutic phenomenological approach a four-step
process was used: 1) Each interview was transcribed by the interviewer and a
reflective memo was written to describe the chronology and sense of the whole
interview (Wertz, 2005). 2) From each interview a reduced narrative was
developed (Wertz). 3) Each reduced
narrative was re-read and themes were coded in the text, focusing on units that
pointed to essential experiences. Imaginative variation was used to sharpen the
sense of which experiences were essential. Imaginative variation is the process used to
determine which themes are incidental and which are essential whereby the text
is imagined without an identified theme. If a theme’s absence does not appear
to alter the essence of the story then the theme is not essential. Otherwise,
it is considered essential and subject to further analysis. Reflection and
constant comparison were used to discern what each theme revealed about the
phenomenon of interest (Caelli, 2001). 4) Reflections were integrated into a
consistent statement that captures the essential quality, meaning and structure
of the experience.
Three methods were used to ensure the trustworthiness of
the study. The first was using what is called a “bracketing” process in
phenomenology. The purpose of bracketing is to neutralize pre-conceived
notions. I had previous experience working with this population as a social
service provider in a housing program and as such this project represented
“practice close research” for me. In order to bracket my experience-related expectations,
I answered the interview questions myself prior to beginning data collection.
In so doing, I tried to neutralize my expectations about others’ experience of
the phenomenon, by becoming acutely aware of them.
The second method of assuring quality of data was
creating an audit trail that was easy to follow by someone outside the study
but familiar with the methodology. The audit trail consisted of full transcripts,
reduced narratives, and all process and analytical memos. Together these
demonstrate the logical process from which I moved from data to final analysis.
Two doctoral-level researchers experienced with the methodology did follow the
audit trail and assessed that the findings were credible.
The final method of assuring the quality of data was in
member-checking. Follow-up contact was made with four of the participants for
the purpose of member-checking and deepening the analysis. All four agreed that
the analysis reflected their experience.
Three themes emerged
from the analysis: (a) providers conceptualized these clients as “survivors” of
remarkable “suffering;” (b) providers saw these survivors as aging into yet
further hardships; and (c) providers engaged in a parallel process of struggling
and coping with their work with these “survivors.” I describe each of these themes
more fully below, where the words and phrases in quotations come directly from
the research participants.
Theme 1: Providers conceptualized these clients as
“survivors” of remarkable “suffering”
The social service
providers in this study unilaterally perceived their clients as “survivors” of
“amazing suffering.” The providers believed the extent of their clients’ “terrible”
past suffering made it “remarkable that they are alive at that age” and remarkable
that they have “not wanted to give-up.” As providers reflected upon the personal
histories of their clients, they considered the impact of time spent in
psychiatric hospitals, being homeless, and/or living without families and friends
in their lives. Most participants also commented about what they imagined their
clients had to endure, using client charts or the history of the mentally ill to
subsidize what their clients had told them directly.
“He told me about… his first long-term psychiatric hospitalization….
and he said that they would make him stay in bed for long periods of time… I’m
thinking that there were some kind of restraints or something…. [He stated]
time would just be very blurred for long periods…. So, I’m thinking he used to
have been over-medicated… And it also made me think… how horrendous… like a
The providers put great effort into describing
accurately and empathically their understanding that the experience of schizophrenia
was a dramatic altering of the life course trajectory into one marked by
“You have a path in life. You’re going on it and then life throws
you this whammy that sort of changes everything that you had envisioned for
your life or what was gonna happen… it’s amazing that no matter what life has
thrown at them, that they’re still working, they’re still trying, they’re still
living. They haven’t just given up. And I think that having an altered sense of
reality is a pretty big… curve ball that life has thrown… and they’re still
Survivorship meant enduring hardships, “still trying;”
“still living;” and “having a niche” wherein they could “exist” with housing
and benefits. What “not-surviving” would have looked like was not explicitly
delineated. Suicide and untimely death of clients was discussed by some
participants, but not necessarily in conjunction with the theme of
survivorship. Self-care neglect and lack of participation in the greater world
were part of “surviving,” not its opposite.
Theme 2: Providers saw these survivors aging into yet
Coplicating the first theme was that the survivorship
of clients was rarely discussed without referring to the ongoing suffering of
the clients, which was so integral to the workers’ understanding of the clients
that only through extensive analysis did it become a clearly separated, albeit
closely connected, theme. I asked all of the providers to describe a day in the
life of their clients and the role they, as survivors, played in it, if any.
This question consistently yielded thick description with accounts of a
client’s history of suffering intertwined with present day activities. But as
they moved from past to present, the providers did not depict the client
prevailing over their suffering and struggles. Rather they saw these clients
moving on to new struggles as they aged, facing yet more suffering, in an
The suffering detailed by the providers manifested
through the convergence of psychiatric and medical health symptoms; through poor
self-care; and through ongoing social isolation. A combination of all of these
aspects of the theme often appeared in narratives about work with a single
client. Thus the suffering of the client became part of the participant’s daily
life through his or her work.
One provider told a
story of a client whose self-neglect and isolation was so severe that wounds on
his skin became “infested with maggots” before he received court-mandated
treatment and protective services. He died from cellulitous.
Another provider told
of a woman who “would lay on the floor all day” despite having a furnished
room, who would refuse medical care despite dangerously high blood pressure,
and who refused all social contact. She had thrown boiling water at a provider
who had over-stepped her bounds. She was in danger of losing her apartment
because of her refusal to fill-out necessary forms that she believed were part
of a conspiracy.
Providers had to cope with client refusal of services,
resulting illnesses and sometimes death. When clients agreed to treatment, lack
of accessibility and/or quality of the services appeared to be worse-than-usual
for them. For example, one client had a leg amputated from complications
related to diabetes, and later developed pneumonia for which he was
hospitalized. The provider described:
“He had soiled himself…. It was a pretty prominent hospital that he
was in, and by the time I got there he [had been] sitting in his own feces for
about two hours… I went through patient advocacy and I made a complaint. And I
think that wouldn’t have happened if there was a family member there… He didn’t
In fact, the provider determined later, upon reflection, the client did
have “someone”—the provider herself, who was charged with providing the care
and support of a family member in this case, and which she did gladly as part
of her work.
Theme 3: Providers engaged in a parallel process of struggling
and coping with these clients
The providers experienced the ongoing suffering and
tragic life events alongside the clients and with the clients. In the cases
above, the providers variously witnessed to skin infested with maggots; had
boiling water thrown at them; and stayed in the hospitals alongside their
clients waiting for them to be cleaned. Thus the client stories became the provider
stories, and the providers experienced emotional consequences as a result.
Often the work was “very sad:”
“In terms of the overall experience… it’s kind of depressing… You
feel sad for them. You want something better for them, but there’s nothing for
them…. Even … if their families took care of them, their lives aren’t going to
look that much different… but you just try to treat them with dignity and
respect and… my hope for the guys I worked with would be that they would just
be stable and live out their lives and die.”
In addition to the sadness, that passage also
encapsulates the sense of hopelessness and frustration that many providers felt.
The experience of hopelessness and frustration is summarized by one provider’s
statement, “We did a lot of work… but it didn’t help.”
All of the providers described feelings of stress.
Stress came from an added “burden of responsibility” or being “worried about so
many different things” including their day-to-day functioning, mental health
and “the medical piece.” At the same time providers felt “more of an investment
to some degree” in the work they did with these clients “because they’re not as
high functioning” as other clients; rarely had anyone else in their lives to
care for them; or because the workers felt responsible for whether the client
lived or died on any given day. The stress attached to the work could be
“exhausting” and punishing. One provider said of the work, “[It] beat the crap
out of me.” Another spoke of it as “traumatic.” One provider felt the amount of
responsibility was “unrealistic and insane.”
To cope with the work-related emotions, providers
engaged in coping that involved cognitive restructuring strategies that enabled
them to have a sense of mastery over their work with these clients and while maintaining
their pre-existing worldview:
“We are the people that they count on. We’re everything. And it’s
nice in some ways… But at the same time it’s also very sad when you’re working
with people who have been estranged from their family… [Pause] I’m just
thinking…. I think that the work that we do is extremely gratifying… because
you’re able to meet them at a very basic level.... You’re able to provide them
housing... You’re able to provide them support… you’re able to be like a
family.... It’s quite an amazing thing. ”
In this passage, the worker fluctuated, first feeling
her work put her in a “nice” situation, then that it was a “sad” one, and
finally, an “amazing” one, when she makes a sudden and distinct shift towards
the determination that, in fact, the work is gratifying. In so doing, she
empowered herself with statements about the mastery she can have over the work,
and adjusted her thinking so that her work can be more inline with an
optimistic worldview. This type of adjustment was common among the providers in
All providers in the study described times at which they
felt unable or challenged to cope. In these cases they spoke of “burnout,”
“meltdowns” and times when they felt like lashing out at the clients because
they were so stressed. Providers believed these feelings signified that it was
time to take a vacation or a “sick day.” One participant started smoking in her
30s in order to cope with the stresses of social service provision in housing.
Two had left work that required them to work with an older mentally ill
population, saying they wouldn’t return “not for any reason” and “just watching
people go through that, I can’t handle that.” Although those providers admired
their clients for “not giving up,” they were not always able to do the same.
Providers also described structural solutions, which
were both innovative and served as a type of instrumental coping for them:
“Being in a housing program, helping people manage their lives in
that way. It’s not easy work, and I’m not sure it’s really what a social worker
should be doing. The pressure… isn’t something necessarily that a social worker
should be charged with. They’re charged with ‘things that the clients bring to
you.’ They’re charged with ‘whatever.’
I think there’s a way the caseloads can be designed differently that would help
them… more specialists in certain ways… versus everybody being an all out
generalist. It’s just exhausting.”
In this passage, the “pressure” of the work is coped
with by finding administrative solutions, wherein the overwhelming scope of the
work could be minimized. The solutions are external and the problems are viewed
as solvable, if exhausting.
Structural features of provider agencies were viewed as
assisting with coping to some extent. Some providers identified a “team”
structure that allowed the burden of the work to be shared among small groups
of service providers. Supervision was only mentioned when I asked about it
directly; some felt their supervision helped them cope and others found it fell
short. Some speculated that caseload-size reduction would improve the
manageability of the work.
The results develop
our understanding of the lived experience of providers in housing programs
sharing the day-to-day lives of older adults with schizophrenia through their work.
The first theme presents to us how providers conceptualize their clients beyond
clinical terms as “survivors,” linking client present-day behaviors to client
histories. This allowed providers to experience empathy and even admiration for
clients when present-day client behavior was perplexing, frustrating, or dangerous.
This mechanism for developing empathy may decrease the potential for
depersonalization of clients that could lead to professional burnout (Harrison
& Westwood, 2009), which can compromise the workplace climate of their
agencies (Glisson, 2007). Research to develop training and education which
develops cognitive strategies for building empathy, and other
psychologically-based interventions or trainings, have the potential to promote
provider coping with workplace challenges and improve agency climates,
ultimately improving the quality of life for the clients served (Jenaro, Flores
& Arias, 2007).
The second theme ties together the first and third
themes. It illuminates the experiences of ongoing hardships faced by the clients
and, as with the first theme, it appeared to serve as a mechanism for
increasing empathy. Through this theme, we gain insight into difficulties in
aging with schizophrenia. The providers detail failures of multiple systems to
adequately deal with the complex convergence of medical and psychiatric
symptoms of these older adults, leading to client housing risk, premature
nursing home placement, and death. Future research that includes the experiences
of front line-providers could be used to develop an understanding of focal
areas for policy-makers and program administrators to target. Continued
advocacy to ensure adequate community resources, well-coordinated responses to
and supports for this population is clearly needed. Additionally, the “further
suffering” of clients tells the story of the workplace of these social service
providers, which provided them with challenges illuminated in the third theme.
The third theme identifies the struggles of the
providers and their need to use coping strategies to manage the disturbing experiences
embedded in the potentially “stressful,” “frustrating,” “depressing,” “sad,”
and/or “exhausting” work. In the literature on coping with physical and mental
illness, coping often requires individuals to revise previously held meaning
structures through dynamic processes (Sharpe & Curran, 2006). The way in
which the providers do this mirrors the way in which persons with physical and
mental illnesses cope (Sharpe & Curran, 2006; Taylor & Stanton, 2007)
and is thus identified as a parallel process in this study. Within the parallel
process of struggling and coping with these clients, providers were required to
self-correct overly pessimistic statements and re-frame their thoughts in more
hopeful terms in a process known as cognitive restructuring. Individual coping
mechanisms can be effectively used across practice settings by social service
providers to address the challenges of their work (Ben-Zur & Michael, 2008)
and to experience the positive effects of engaging in challenging areas of
social service provision (Dane & Chachkes, 2008).
However, their attempts to cope were not always
successful, and even successful coping strategies do not entirely prevent the
onset of negative emotional responses to work or burnout (Jenaro et al., 2007).
The term “burnout” describes a combination of work-related emotional
exhaustion, depersonalization of clients, and a decreased sense of personal
accomplishment (Jenaro et al., 2007; Lloyd et al., 2002; Wharton, 2008). The many
emotions described by the providers are connected to the “emotional exhaustion”
feature of burnout, while the sense that “we did a lot of work… it didn’t help”
speaks to a decreased sense of personal accomplishment. The permanent departure
of two participants from the work suggested the full burnout syndrome might
have been experienced. That the providers experienced aspects of burnout is not
surprising, since it occurs at high rates among providers to vulnerable
populations (Lloyd et al., 2002; Wharton, 2008), particularly in work with
vulnerable populations of older adults (Bourassa, 2011; Duffy, Oyebode &
Allen, 2009) and with adults with serious mental illness (Acker, 2010; Acker
agencies serving older adults with schizophrenia should therefore closely
monitor staff for burnout, since burnout and related staff turnover can
decrease the quality of social services provided by an organization (Glisson,
2007; Lloyd, King & Chenoweth, 2002; Wharton, 2008).
Providers also used solutions-focused coping strategies; the implementation
of their solutions may have the potential to decrease provider burnout. For
example, some relied upon supervision for debriefing and support, while those
who did not have that opportunity envisioned better supervision. Supportive supervision has been
demonstrated to decrease burnout, absenteeism, and turnover (Acker, 2011;
Eriksson, Starrin & Janson, 2008; Lloyd et al., 2002). The HUD guide for developing social services in supportive housing
acknowledges the demanding nature of the work and the related problem of staff
turn-over, recommending supportive and educational supervision (Hanrihan & Wagner,
2003), however in practice supervision often fell short of what providers felt
they needed. Agency-based measures that ensure social
service providers are provided with adequate support through strong supervision
could improve the ability of providers to cope with their difficult work.
It may be that the mandate for the housing service
providers to do “whatever it takes,” as described in the case management in
supportive housing training manual (CUCS, 2011), is counter-productive. Participants
connected the pressure related to the work, and the related stress, to the “unrealistic”
broadness of working on “whatever” comes up for the client. One worker
suggested more clearly specified worker roles and partitioning direct-practice
positions into sub-specialties, which could decrease the broadness of what is expected
of the providers, and in turn the related emotional consequences. Another way
to change caseloads in order to improve structural support would be to limit
the number of cases with regard to client
issues. High need clients could be placed on smaller caseloads. Although the
HUD guide recommends a staff-to-client ratio ranging from 1:10 to 1:30 per
direct social service provider, the circumstances under which such ratios
should be distributed is not specified (Hanrihan & Wagner, 2003).
aim of this study has been to discern the essential
experience of housing-based social service provision for older adults
schizophrenia in order to develop and improve workplace climates, and,
extension, service provision. An advantage of the study design is that
not bounded by a specific housing organization, thus results spoke to
cross-organizational experiences in working in the same setting type
same population. However its focus on specific housing-types and
limit generalizability of the findings, as does its exploratory nature.
gleaned from the study must therefore be considered cautiously.
the first theme could be channeled for use in training and education to
practitioners and students develop empathy for challenging client
Findings from the second theme suggest a need for improved services and
service-coordination for older adults with schizophrenia. Findings from
the third theme speak most directly to the study
purpose, suggesting organizational shifts geared towards improving work
climates of housing programs. These include more workplace support via
improved supervision. Also included is more clearly specified and/or
specialized provider roles, and decreased caseloads. Such shifts may
the sense of burden and feelings of stress, and allow for providers to
sense of mastery and professional accomplishment that is not based on
individual coping strategies. Further research is needed to understand
practitioner workplace experience with vulnerable and challenging
can be adjusted to improve workplace climates and service effectiveness.
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