Community-Built Occupational Therapy Services for Those Who Are Homeless
Total Page：16
File Type：pdf, Size：1020Kb
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details. Community-Built Occupational Therapy Services for Those Who Are Homeless Winifred Schultz-Krohn, PhD, OTR/L, BCP, SWC, FAOTA and Urban Development [HUD], 2017). Although there is no Professor and Chairperson of Occupational Therapy definitive cause of homelessness, the National Coalition for San Jose State University the Homeless (2009) reported that substance abuse; mental San Jose, CA illness; domestic violence; and recent economic factors, such as decreases in public assistance programs and loss of jobs, are the Quinn Tyminski, OTD, OTR/L most prevalent causes of homelessness. Homelessness has been Occupational Therapist identified as an issue within the United States for more than 8 Washington University in St. Louis decades, but the composition of the homeless population has St. Louis, MO changed dramatically in the past 40 years. In the 1950s to 1970s, the overwhelming majority of those who were homeless were This CE Article was developed in collaboration with AOTA’s single men (Burt et al., 2001). During the 1980s, more families Home & Community Health Special Interest Section. were experiencing homelessness, and currently more than a third (35% to 37%) of the homeless population are members of homeless families (National Alliance to End Homelessness, ABSTRACT 2018). This change in the homeless population created the need More than 500,000 people experience homelessness on any for new services and supports. In 2017, approximately 65% of given night in the United States (U.S. Department of Hous- the total homeless population was living in emergency shelters ing and Urban Development, 2017). Even with the large need or transitional housing programs, and more than 184,000 were for services to support occupational engagement, health, and homeless individuals in families with children (HUD, 2017). well-being, the National Coalition for the Homeless (2009) Nearly 30% of the total sheltered homeless population is indi- reported that the majority of homeless individuals have access to viduals in homeless families (HUD, 2017). Homeless families few supportive services. Individuals experiencing homelessness typically consist of a single mother younger than 30 years of often do not have access to housing, health-related, or trans- age and with two or three children younger than 5 years of age portation resources, and are not provided education for health (Bassuk Center on Homeless and Vulnerable Children & Youth, maintenance, skills attainment, or home management. Often, 2015). Homeless mothers experience higher levels of mental underserved populations are not covered by traditional medical health issues, poor physical health, increased stress, loss of or educational services, yet they still have occupational needs. social supports, and deterioration of parental roles than housed This article outlines the theoretical foundation for occupational low-income mothers (Helfrich et al., 2006; Schultz-Krohn et al., therapy treatment for homeless individuals as well as treatment 2006). options for occupational therapy practitioners working with this Even with the large need for services to support occupational population. engagement, health, and well-being, the National Coalition for the Homeless (2009) reported that the majority of homeless LEARNING OBJECTIVES individuals has access to few supportive services. Individuals After reading this article, you should be able to: experiencing homelessness often do not have access to housing, 1. Identify barriers preventing full occupational engagement health-related, or transportation resources and are not provided among various populations experiencing homelessness with education for health maintenance, skills attainment, or 2. Discuss the role of occupational therapy within the homeless home management. Although many organizations exist within population the community to provide health care and supportive services 3. Identify the differences between community-based and com- to people without housing, the lack of funding for these services munity-built services results in strict inclusion criteria, long wait times, and stringent 4. Identify the occupational needs of various subgroups in the availability (National Alliance to End Homelessness, 2017). homeless population Other barriers to accessing services for individuals experiencing homelessness include lack of transportation to attend appoint- INTRODUCTION ments, job interviews, or educational classes outside of their More than 500,000 people experience homelessness on any immediate area; poor literacy skills, resulting in the inability given night in the United States (U.S. Department of Housing to complete necessary paperwork; lack of material resources WWW.AOTA.ORG ARTICLE CODE CEA0618 CE-1 Continuing Education Article Download the CE Exam Click here to purchase and take the exam for CE credit. (e.g., telephone access); and concern about stigma from staff at occupational participation because of race, religion, and/or support organizations (National Alliance to End Homelessness, sexual orientation are examples of occupational apartheid. 2017; Roy et al., 2017). Occupational imbalance refers to excessive engagement in one Research findings have indicated that individuals experi- occupation or group of occupations to the exclusion of other encing homelessness are provided with limited opportuni- occupations. This imbalance can compromise health, such as ties to engage in meaningful occupations and therefore have when parents need to work two to three jobs to support the decreased health outcomes, social interactions, and well-being family. Occupational alienation is when individuals or pop- (Glass et al., 2006). The element of personal choice is essential ulations are not able to engage in meaningful activities and to deriving meaning from occupations, yet the institutional instead engage in tasks whose requirements do not reflect nature of the homeless shelter environment requires individuals their full capabilities. An example of occupational alienation seeking services to abide by strict curfews, mealtime sched- could be when a woman living on the streets rummages ules, and mandatory check-ins, resulting in few opportunities through garbage cans to find plastic bottles to recycle for cash. to make choices about occupational participation (Glass et al., Occupational deprivation is a common form of occupational 2006). Additionally, one study attributed the high prevalence of injustice where illness or disability prohibits engagement substance abuse within the homeless population to the minimal in meaningful occupations. An example could be when a opportunities available for occupational engagement (Brad- musician with severe arthritis is no longer able to play the ley et al., 2011). Similarly, homeless shelters do not provide piano. Occupational marginalization is the injustice seen when opportunities for functional skill development (Illman et al., everyday options or choices are not available to every member 2013). Based on the current literature available, it is evident that of the society or community. An example could be persistent within the homeless population many barriers exist that prevent gender roles that restrict an individual’s options. full engagement in meaningful occupations, therefore requiring Occupational therapy services are continuing to evolve to occupation-based intervention services. meet the occupational needs of an ever-expanding number of client groups. The American Occupational Therapy Associa- THEORETICAL FOUNDATION tion’s (AOTA’s) Vision 2025 calls for the profession to “maximize The model of occupational justice was described by Townsend health, well-being, and quality of life for all people, populations, and Wilcock (2004) as a right of all individuals to participate in and communities” (AOTA, 2017, p. 7103420010p1). To help meaningful everyday occupations. The concept of occupational achieve this vision, practitioners can identify not only the occu- justice was built on a foundation of client-centered services, pational needs of current groups served, but also the needs of engagement in occupations as health promoting, and social underserved people, populations, and communities. justice. Specific elements of occupational justice include the concepts of enabling fairness and equal opportunity, removing Community Built, Not Community Based discriminatory practices that are based on age or other factors, a When attempting to address the occupational needs of new clear commitment to universal design, and providing a contex- and underserved populations and communities, a commu- tual position that enables everyone to individually flourish as nity-built model offers guidance and structure. Although a member of a community. Marginalized populations seldom many occupational therapy services are provided within have opportunities to engage in meaningful occupations, and a community-based setting, there is a distinct difference this is where occupational therapy services can diminish the between a community-based and a community-built model of occupational injustices by facilitating occupational participation service delivery (Schultz-Krohn, 2012). In a community-based (Townsend & Whiteford, 2005; VanLeit et al., 2006). model, the occupational therapist determines what services Although occupational justice is often compared to social will be provided and the frequency of services. Although the justice, it is considered a distinct