Client-Identified Needs and Agency-Provided Services At a Harm Reduction Community Based Organization in the District of Columbia
Harm reduction case management relies on client-identified goals to drive the provision of care in order to “meet clients where they are at”. This research measured the level of agreement between client-identified needs and agency-provided services at a community based organization (CBO) in Washington DC by examining: (1) the services clients most often identified, (2) the services most often given to clients by the CBO, and (3) the level of alignment between client-identified needs and services provided.
Case file reviews were completed for 151 clients who received case management services at the CBO between January 2010 and February 2011. Client-identified needs and agency-provided services were extracted from case files and divided into 9 matching need and service categories: pharmaceutical assistance (e.g., prescription renewal), medical or dental care, housing, mental health services, substance use services, support services (e.g., support group meetings), legal assistance, and employment/job training. Client-identified needs and services provided were analyzed using McNemar’s Chi-square to assess for significant differences in discordant pairs.
Clients were mostly Black (90.7 %), heterosexual (63.6 %), HIV positive (93.4 %), and over 40 years old at the time of intake (76.2 %). On average, clients identified 2.44 needs and received 3.29 services. The most common client-identified needs were housing (63.7 %), support services (34.3 %), and medical/dental care (29.5 %). The most common agency-provided services were housing (58.2 %), support services (51.4 %), and medical/dental care (45.2 %). In 6 of the 9 service categories, there were statistically significant (p < .01) differences between those who received services not asked for and those who did not receive asked for services in the categories of pharmaceutical assistance, medical/dental care, substance abuse services, support services, legal assistance, and food access. In each of these matched service categories, the %age of clients who received services not asked for was significantly higher than those who did not. CONCLUSION: This research shows that, while there is general alignment between the services that clients most often want and the services most often provided, there are still instances where services are requested but are not being provided.
Overview of article
- This article measured the level of agreement between client-identified needs and agency-provided services at a community based organization (CBO) in DC by examining: 1) The services clients most often identified; 2) The services most often given to clients by the CBO; and 3) The level of alignment between client-identified needs and services provided
Methods of article
- Case file reviews were completed for 151 clients who received case management services at the CBO. The files included information, such as client demographic characteristics, mental health issues and needs, substance use-related issues and needs, medical history, client-identified goals for engaging in services, and referrals and services provided by the agency
- On average, clients identified 2.44 needs and received 3.29 services. Overall, the most frequent client-identified needs were housing, support services, and medical or dental care. The most frequently provided services across all clients presenting for services by the CBO were housing, support services, and medical or dental care, suggesting alignment between client-identified needs and provision of these specific services
- 6 service categories were identified as disconcerting (e.g., services requested but not provided): 1) Pharmaceutical; 2) Medical or dental care; 3) Substance abuse services; 4) Support services; 5) Legal assistance; and 6) Food access
- A large percent age of patients received services that they did not self-identify as a need. Future research should focus on evaluating this finding
- Given the breadth of research linking stability in housing to positive outcomes in other areas, future work should examine the stability of the housing that was provided to clients and the impact that stable housing has on CBOs’ ability to address clients’ other identified areas of need
- Future research is needed to examine how clients perceive and understand the barriers that may be in place that limit their access to necessary resources and services, and how case management service providers address these perceptions in the course of addressing clients’ needs
- Evaluation of operational, technical and infrastructural barriers (e.g., limited staff support) should take place to determine its effect on provision of care
- Limitations include reliance on self-reported data by case managers, lack of provision of all services patients identified as a need, potential impact of barriers (e.g., financial constraints) on provision of care by CBOs, and constraint of number and range of possible needs (maximum of 3 of 9 pre-established categories)