Cedar Tremont HouseProject Return FoundationNew York, N.Y.

Project Return Foundation, based in New York, N.Y., won third place in the Supportive Housingcategory of the 1998 Metropolitan Life Foundation Awards. The organization was honored for CedarTremont House, a project that provides permanent housing and comprehensive supportive services forfamilies living with HIV/AIDS. Project Return has evolved from a storefront in mid-town Manhattan,offering substance abuse treatment and prevention programs, into an agency that operates 16 programs at10 locations in Manhattan and the Bronx and provides a full continuum of care to its clients. The focusof Project Return has moved beyond treatment to include assistance with living independently, jobreadiness, re-establishing households and reconnecting family members.

Comprehensive Services

Cedar Tremont House in the Bronx, N.Y., (a projectof the Project Return Foundation) provides residentchildren with both an indoor play area (picturedabove) and outdoor recreational space. After-schoolprograms and arts and crafts classes are alsooffered to the children.

The services at Cedar Tremont are designed around theneeds of parents living with HIV/AIDS and theirfamilies. This approach is standard for case managementmodels of service provision. It is also standard forprograms dealing with individuals who have substanceabuse recovery issues, as do most of the Cedar Tremontresidents. At move-in, a thorough intake screening isconducted with each family, during which the parentsare asked about their plans for living with HIV/AIDS,for continued substance abuse recovery and for dealingwith family issues (many resident families have recentlybeen reunited after years of such things as drug abuse,foster care and incarceration).

The intake procedure allows Cedar Tremont and theresidents to identify needs and expectations together.The dialogue format also makes the services at CedarTremont user friendly. In addition to the extensiveintake screening process, the other primary key forsuccess is flexible programs which accommodatechanging tenant needs. This flexibility has been criticalgiven the advance of drug therapies for the treatment ofHIV/AIDS (during initial program planning, forexample, building tenancy was expected to turn overentirely within 12 to 18 months due to death). To date,there have been no deaths at Cedar Tremont (thebuilding opened in April 1996). Planning for dying hasturned into planning for living. In addition to casemanagement, Cedar Tremont also offers a variety of

programs and group sessions, including computer training, a women�s group, substance abuseworkshops, after-school programs, arts and crafts and nutrition and group parenting classes.

Individual and Family Empowerment

The objective of individual and family empowerment is fundamental to the service mission of CedarTremont, and is reflected in the design of the service programs and the philosophies of the staff. Fromthe intake interview on, residents are encouraged to become stakeholders in their own improvement andgrowth as well as that of the project. This is achieved through activities that foster self-esteem, frequentopportunities for tenant feedback and the activities of the Tenant Advisory Association that meetsmonthly. Although most of the residents face an array of difficulties, the program�s basic goal is alwaysto provide them with a learning process and the tools to manage their lives and families on their own.

Cedar Tremont and the Neighborhood

General outreach to the local neighborhood has also been a primary goal for the staff and residents ofCedar Tremont, often through the vehicle of youth involvement. While prior to opening, Project Returnreceived considerable "not-in-my-backyard" opposition, Cedar Tremont has developed relationships witha wide array of community members. For example, Cedar Tremont staff and residents make an effort topatronize local businesses and are working on establishing ties with the local fire department.

Communication

Cedar Tremont staff and residents have an open channel of communication, both formally throughservice-provision functions, and informally. Staff members, including the site director, are individuallyresponsive and are available on a regular schedule, and on call. In addition, the residents� council has aclear channel of communication with staff. Other channels of communication include the women�s groupand other support groups and staff and tenant events.

Physical Design

The design elements of Cedar Tremont are particularly striking, both in the quality of the finishes as wellas in the layout and amenities. With high standards for an attractive environment (within subsidizedhousing budget limitations), the building was carefully designed to assist HIV-positive parents withcaring for themselves and their families. In the predevelopment stage of the project (1992), ProjectReturn engaged an environmental psychologist and design consultant, Dr. Richard Olsen, to prepare auser-need analysis to guide the building�s design.

Each residential floor was designed with three units and a pleasant sitting area in the main hallway toencourage socializing and bonding among neighbors. Bedrooms are located away from the hallway, soparents who are resting won�t be disturbed. Public spaces are brightened by culturally relevant artwork,including colorful fabric panels with floor numbers across from each elevator opening, so residents caneasily know what floor they are on.

Inside the apartments, the layouts and sight lines were planned so parents can see the kitchen and livingroom from their bedroom and keep an eye on their children. Some special design features include asmall, enclosed kitchen to retain cooking smells potentially disturbing to a parent suffering from nausea,oversized medicine cabinets, lights with dimmer switches, ceiling fans in each room and the publichallways, air conditioners in the living room and the master bedroom and an additional private toilet andsink off the master bedroom. Each unit also has its own washer and dryer in case residents become too ill

All of the rooms in the apartments at Cedar TremontHouse are designed specifically for the specialneeds of the residents living with HIV/AIDS. Thekitchens, for example, are small and enclosed toretain cooking smells that may bother residentssuffering from nausea.

to do laundry in the basement.

Flexibility in the design has been particularly important,as service needs have changed. For example, an officehas been turned into a computer-learning lab. The sizeof the original furnishings were considered for theirflexibility, including drop-leaf tables and living roomchairs that can open into a single bed for guests orcaregivers.

The building design uses outdoor recreational spacewherever possible and in a variety of settings. Thechildren�s play space in the central courtyard is situatedoff the community room on one side and staff offices onthe other, with window sight lines for maximumsupervision.

Cedar Tremont Housing is home to 17 families livingwith HIV/AIDS. The families are offered a variety ofcomprehensive support services, including computertraining, substance abuse workshops and nutritionand parenting classes.

Every possible space is developed to provide outdoorsettings for various activities, including resting, visitingand watching the children. A roof deck with seating anda gazebo overlooks the Harlem River and the Manhattanskyline. The roof deck also serves as a location forparties and tenant gatherings and the building has asmall side yard with seating.

Security and safety are important aspects in the building�s design. Electric stoves were chosen over gas in theevent of dementia problems. There is safety flooring inthe outdoor play areas, all units have child windowguards and there are chair rails in both the units andpublic spaces. There is front-desk security and atelephone intercom to each unit. Dishwashers wereinstalled for cleanliness and all flooring is slip-proof.Units are handicapped adaptable and have hand-heldshower heads, but were designed to avoid aninstitutional atmosphere.

Resident Involvement

Mechanisms for resident involvement include theTenant Advisory Association, which meets every month,and includes officers and floor captains of the sixresidential floors. These meetings are directly followedby general tenant association meetings. Other residentinvolvement is available through events, parties, classesand one-on-one interaction with staff. There are formalmechanisms for tenant issues and complaints to staff, as well as open-door policies with every staffmember for individual discussions.

Outcomes

The program has measurable outcomes for each resident through both individual and family serviceplans. Individual measures include program participation, attendance, participation in vocational rehaband employment, medication management, relapse rates, pregnancies, primary care utilization andchildren�s school attendance.

Cedar Tremont has been successful in meeting these outcomes. Since the building was opened andresidents moved in, 82 percent of the residents have maintained stable living arrangements for more thantwo years and 75 percent of the adult population has remained abstinent from illicit substance use.One-hundred percent of residents use primary medical care and 85 percent of the AIDS-diagnosedtenants are adhering to their medical regimen.

Both short- and long-term outcomes are monitored as a fundamental part of the case managementprocess. This includes baselines from initial intake screenings and psychosocial reviews, interimmonitoring with individual client and case worker meetings, monthly case conferences between theclients and the staff working with them and 90-day treatment plan reviews.

Resident ProfileOne tenant, a 31-year-old woman with six children, three of whom (ages 13, 14 and 15)now live with her, says that the Cedar Tremont program changed her life. This is her firstapartment on her own; she has lived here for 18 months. Since moving in, she was able toget her children back. She has been drug-free for two years and is doing things she neverthought she could, including learning to read, earning her driver�s license and buying herown living room furniture. Her children have become involved in the youth activitiesoffered at Cedar Tremont, especially the computer lab that has Internet access. She is proudof herself and knows that the Cedar Tremont staff is always there for her.

Project SummaryWinning Project:Cedar Tremont House

Project Type:17 two-bedroom units of permanent, family housing.●

11 units have a separate dining room that can be converted into a caregiver�s bedroom ifnecessary.

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Resident Profile:Family sizes range from one to five, with an average of 3.5.●

All residents earn below 30 percent of the area median income.●

Rent Structure:

Households in which a family member is living with HIV/AIDS receive a rental subsidy from the NewYork City Department of AIDS Services.

Occupancy Rate:

88 percent

Project Cost:

Development: $2.9 million ($170,588 per unit)

Key Features:Design elements geared towards families living with HIV/AIDS●

Constant dialogue between tenants and staff to facilitate family and individual empowerment●

Flexible programs to respond to changing needs of tenants, especially related to the increased lifespan of individuals living with HIV/AIDS

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Key Services:Financial planning and management and case management●

Substance abuse counseling and education and referrals●

Health education and HIV support groups●

Workshops on various topics including adult literacy, parenting and living skills and stressmanagement

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Cedar Tremont HouseJane VelezExecutive DirectorProject Return Foundation10 Astor Place, 7th FloorNew York, NY 10003Ph: 212.979.8800Fax: 212.979.0100