The meaning of family routines in a homeless shelter

An Argument for Guidelines for Capstones in Unhoused Settings

In recent years, there has been increased interest in completing occupational therapy doctoral capstones with people experiencing homelessness. Given the complexity of practice with this population and its history of discrimination and marginalization, we argue for the development of guidelines for completing capstones in unhoused settings. In this column, we present background and contextual information, justification for the need for guidelines, and preliminary recommendations for consideration by students and faculty. Our aim is to invite reflection within the profession and among academic institutions and to promote dialogue with community agencies that serve this population to ensure that capstones are developed ethically, sustainably, and without unintentionally perpetuating harm.

Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Advocating for Change to Meet the Developmental Needs of Young Children Experiencing Homelessness

Young children experiencing homelessness are at considerable risk for developing physical and cognitive impairments, yet federal and state programs often overlook their needs. Although early intervention programs should serve as family-centered, health-promoting resources for families experiencing homelessness, many do not locate and comprehensively screen eligible children ages ≤3 yr in their communities. Occupational therapy practitioners have a role in advocating for improved access to high-quality, federally mandated programming for this population. They should be aware of the barriers faced by homeless families in accessing equitable early developmental services and of strategies to support individual families and communities experiencing homelessness.

'Every day is hard, being outside, but you have to do it for your child': Mixed-methods formative evaluation of a peer-led parenting intervention for homeless families

We conducted a mixed-methods, formative evaluation of a peer-led parenting intervention for homeless families. Participants were parents living in temporary accommodation with self-identified difficulties related to parenting an index child aged 2-11 years. An evidence-based programme ('Empowering Parents, Empowering Communities') was adapted for delivery with the target population in London, UK. We assessed feasibility in terms of session attendance rate, intervention completion rate and potential for impact on a range of parent-reported outcomes measures. Acceptability and appropriateness were examined by a user satisfaction measure and qualitative interviews. The intervention was delivered across three group cohorts (N = 15). Thirteen parents completed the programme (including one parent who required two attempts). We found improvements in child behavioural difficulties, parenting knowledge and practices, while parental well-being and social support were unchanged. Participants were highly satisfied overall, with indications that the peer-led model mitigated negative expectancies of services and normalized experiences of parenting in challenging conditions. Parental self-care and 'the good enough parent' were strongly endorsed topics, although some content (e.g. timeout) was deemed impractical. These promising findings warrant further testing under controlled conditions.

How Does Homelessness Affect Parenting Behaviour? A Systematic Critical Review and Thematic Synthesis of Qualitative Research

The adverse social and physical conditions of homelessness pose significant developmental risks for children, which may be compounded or buffered by the quality of parenting behaviour they are exposed to. There is currently a limited understanding of how parents approach their care-giving role and responsibilities while adjusting to the experience of homelessness. Advancing knowledge in this area is essential for developing acceptable, appropriate and effective interventions to support highly marginalised and vulnerable homeless families. This review explored homeless parents' perceptions of how homelessness affects their parenting behaviour and identified adaptive strategies that parents may use to mitigate the potentially negative impacts of homelessness on the quality of care-giving. A systematic search of four electronic databases (ASSIA, PsycINFO, Web of Science and MEDLINE) identified 13 published qualitative studies, all originating from the USA, which explored parenting behaviour in homeless contexts. The studies were critically appraised using the CASP qualitative assessment tool. Thematic synthesis identified the following determinants of parenting behaviour; negative self-concept in the parental role, parental mental health, material resources, challenges to autonomy and self-efficacy, daily hassles, physical environment and service context, stigma, child characteristics and lack of support. These were synthesised thematically using existing models of parenting determinants and positive parenting. Findings indicate substantive impacts of homelessness on parental mental health, parenting authority, material resources, parenting environments and social support. Parents developed a number of adaptive methods to negotiate the challenges of homeless parenting such as maintaining a positive mindset, cherishing the parental role and developing practical strategies. We conclude with recommendations that service providers should tailor parenting support to resource-constrained circumstances and that further research is required in order to better understand experiences of homeless parents in other international contexts.

Adapting and Pilot Testing a Parenting Intervention for Homeless Families in Transitional Housing

Intervention adaptation is a promising approach for extending the reach of evidence-based interventions to underserved families. One highly relevant population in need of services are homeless families. In particular, homeless families with children constitute more than one third of the total homeless population in the United States and face several unique challenges to parenting. The purpose of this study was to adapt and pilot test a parenting intervention for homeless families in transitional housing. An established adaptation model was used to guide this process. The systematic adaptation efforts included: (a) examining the theory of change in the original intervention, (b) identifying population differences relevant to homeless families in transitional housing, (c) adapting the content of the intervention, and (d) adapting the evaluation strategy. Next, a pilot test of the adapted intervention was conducted to examine implementation feasibility and acceptability. Feasibility data indicate an intervention spanning several weeks may be difficult to implement in the context of transitional housing. Yet, acceptability of the adapted intervention among participants was consistently high. The findings of this pilot work suggest several implications for informing continued parenting intervention research and practice with homeless families in transitional housing.

Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing

Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off 'ripple effects' within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services.

Occupation-based practices and homelessness: A scoping review

Background.

Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession.

Purpose.

This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness.

Method.

A scoping review was conducted, including evidence from both occupational therapy and non–occupational therapy sources.

Findings.

One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief.

Implications.

Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.

The Association Between Shelter Rules and Psychosocial Outcomes Among Homeless Youth Residing in Family Shelters

Despite growing numbers of homeless youth living in shelters with caregivers, little research has explored the impact of the shelter environment on emotional well-being. As such, this study assesses the relationship between shelter rules and two psychosocial outcomes among youth in New York City family shelters. Additionally, the direct effect of trauma and the moderating effect of difficulty following shelter rules on psychosocial outcomes was assessed. Youth with difficulty following shelter rules reported significantly more depressive symptoms, but less substance use. Trauma was found to be associated with increased depression and substance use. Difficulty following shelter rules was found to moderate the association between trauma and substance use. Recommendations for future interventions and the creation of shelter policies are discussed.

Causes of homelessness prevalence: Relationship between homelessness and disability

AIM

Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system.

METHODS

The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results.

RESULTS

Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability.

CONCLUSION

Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems.

Rotinas Familiares de Crianças com Necessidades Especiais em Família Adotiva

RESUMO Objetivou-se descrever as rotinas de três famílias, que adotaram crianças com necessidades especiais ,que tinham conhecimento prévio dessa condição infantil. Utilizou-se o método de Estudo de Casos Múltiplos. Os dados foram obtidos por meio de Entrevista Semiestruturada (ES), do Inventário de Rotina (IR) e do Diário de Campo (DC). Quanto às semelhanças entre os grupos familiares, identificou-se que são comuns as atividades de alimentação/higiene, descanso e lazer, envolvendo a participação dos pais, irmãs e babás, geralmente nos ambientes domésticos da família. Observou-se diferenças importantes nos padrões de atividades, companhias e ambientes onde as rotinas ocorriam. Conclui-se que as variações nas rotinas estão relacionadas às particularidades de cada criança, à estrutura e nível socioeconômico de cada família participante.

Assessing the Relationship Between the Perceived Shelter Environment and Mental Health Among Homeless Caregivers

Little attention has been given to how the environment of homeless shelters may impact the mental health of their residents. This study addresses this gap in the literature and presents a cross-sectional analysis of 209 caregivers nested within 10 family shelters across New York City. Multivariate regression was employed using hierarchical modeling to test the association between two shelter related variables (ie, the perceived social environment of the shelter and difficulty following shelter rules) and the mental health status of the caregiver residents. Less favorable perceptions of the social environment of the shelter and difficulty following shelter rules were both found to be associated with poorer mental health after controlling for demographic covariates as well as time in the shelter and first time in the shelter. These findings highlight the potential impact of the perceived social environment of shelters and methods of governance of shelters on the mental health of caregiver residents. In addition, the findings support the notion that interventions such as trauma informed care could potentially aid in addressing the mental health challenges that residents face.

The Unique Relations between Early Homelessness and Educational Well-Being: An Empirical Test of the Continuum of Risk Hypothesis

This study examined the Continuum of Risk Hypothesis by assessing the unique relations between early homelessness and educational outcomes while controlling for co-occurring risks. An integrated data system was used to account for multiple co-occurring early risk factors for an entire cohort of first grade students in a large urban school district and municipality (N = 8,267). Multilevel linear regression models indicated that the presence of some co-occurring risk factors explained the relation between homelessness and academic engagement problems in school. However, after controlling for co-occurring risks, an experience of homelessness was found to be uniquely related to social engagement problems in first grade. These results support the Continuum of Risk Hypothesis and stress the importance of early intervention for children with an experience of homelessness to foster their social development.

Families experiencing housing instability: the effects of housing programs on family routines and rituals

Maintenance of family processes can protect parents, children, and families from the detrimental effects of extreme stressors, such as homelessness. When families cannot maintain routines and rituals, the stressors of poverty and homelessness can be compounded for both caregivers and children. However, characteristics of living situations common among families experiencing homelessness present barriers to the maintenance of family routines and rituals. We analyzed 80 in-depth interviews with parents who were experiencing or had recently experienced an instance of homelessness. We compared their assessments of challenges to family schedules, routines, and rituals across various living situations, including shelter, transitional housing programs, doubled-up (i.e., living temporarily with family or friends), and independent housing. Rules common across shelters and transitional housing programs impeded family processes, and parents felt surveilled and threatened with child protective service involvement in these settings. In doubled-up living situations, parents reported adapting their routines to those of the household and having parenting interrupted by opinions of friends and family members. Families used several strategies to maintain family routines and rituals in these living situations and ensure consistency and stability for their children during an otherwise unstable time.

Promoting positive parenting in the context of homelessness

Recent national reports suggest that nearly 1,000,000 families with children experience homelessness and that this number is rising (National Center on Family Homelessness, 2009; U.S. Conference of Mayors, 2010; U.S. Department of Housing and Urban Development, 2011). Families experiencing homelessness are disproportionately more likely to have experienced economic, health, and social risk factors. These experiences can adversely influence the parent-child relationship. The purpose of this article is to (a) review the literature on the determinants and contextual issues of parenting in shelters; (b) describe specific programs that are focused on positive parenting in the context of homelessness; and (c) provide practice, research, and policy recommendations for supporting positive parenting among families living without homes.

The effect of family routines on care for inner city children with asthma

This article provides the results of a study utilizing baseline data from the School-Based Asthma Therapy Trial, an ongoing comprehensive school-based intervention for urban children. We examined the effect of family routines as measured by the Asthma Routines Questionnaire on asthma care measures of trigger control and medication adherence, as well as on parental quality of life. We found that families with more asthma routines had better adherence with preventive medications (r = .36) and less exposure to environmental triggers (r = -.22). These findings suggest that assisting families in developing routines around asthma care might improve preventive care for urban youth.

The role of an Australian homeless health outreach team. Part 2: a case study

Background

Throughout the western world, the issue of homelessness has been receiving increasing attention. As a government response to homelessness in Australia, the Queensland State Government developed a strategic plan to address this issue, establishing Homeless Health Outreach Teams.

Contents

This article follows on from the previous issue, where the background to a team's formation is discussed. This article continues this discussion by describing a case study of a homeless service user. The areas that are addressed include the team involvement, recommendations for continuing treatment, and the practical ways in which the service user was assisted.

Conclusions

A key feature of team's work was the close working relationships established with both the non-government and government sectors in order to address the service user's complex needs. The work was challenging, but the potential of working in this way with a population experiencing homelessness is only limited by the creativity of the team.

Time Use of Women with Children Living in an Emergency Homeless Shelter for Survivors of Domestic Violence

Time use patterns were systematically assessed in a sample of women with children living in a domestic violence shelter. A convenience sample of 23 women residing in a homeless shelter for women escaping domestic violence participated in this study. Time use patterns were obtained by the participants verbally reviewing a previous weekday and weekend day with the research team members. While staying at an emergency shelter for women fleeing violence, the women in this study spent significant amounts of time in sleep and rest activities, passive recreation, and socializing with other shelter residents. The daily activities engaged in by women with children living in an emergency shelter for survivors of domestic violence reflect the complex housing and personal transitions they face. Their activity patterns reflect the prevalence of psychiatric symptoms and conditions in this population and the crisis nature of surviving without stable housing in a shelter.

Conducting filial therapy with homeless parents

Homelessness and the associated feelings of loss are highly distressing for parents and their children who experience them. The implications for young, homeless children are clinically significant, as these children tend to display higher rates of depressive, anxious feelings. The literature suggests that parents are especially challenged during a period of homelessness, as they cannot provide for their children financially or emotionally. Evidence-based mental health interventions, such as filial therapy, may assist the parent-child relationship by promoting healing during a highly distressing event such as homelessness. Filial therapy, derived from child-centered play therapy, teaches parents to play with their children to express feelings and gain mastery over difficult and often disturbing thoughts and emotions. This article's purpose is to (a) educate clinicians about the psychological complexities of homelessness with parents and their children and (b) highlight the benefits of using filial therapy as an evidence-based intervention with this population.

Exploring Occupation and its Meaning among Homeless Men

Few studies have been conducted that address homelessness from the perspective of those who have experienced it. Studies tend to focus on services for homeless people, with little description of occupational engagement and the experiences of the homeless people themselves.

This qualitative study, conducted within a phenomenological tradition, explored the lived experiences of adult men living in an inner-city shelter. Eight individual, unstructured interviews were carried out. In addition, three visual notebooks were compiled by the men, using photographs and text that illustrated the occupational realities of their life-world.

Inductive, narrative analysis revealed four themes: keeping busy; street-life environment; loss; and revelation and sharing of self. The findings provide insight into the lives of homeless men. They therefore help to inform occupational therapy within a shelter environment in order to facilitate the homeless men moving forward to increased and more meaningful engagement in occupation and independent lives.

The relationship of household routines to morbidity outcomes in childhood asthma

PURPOSE

The major purpose of this study was to explore the effect of routines on asthma management and morbidity outcomes for children with asthma and their parents.

DESIGN AND METHODS

This study is a secondary data analysis in a sample of 150 children, which was originally used for an intervention study.

RESULTS

Parents who had fewer routines in their homes had lower quality-of-life scores and higher burden of asthma scores when compared to parents in households with more routines. More routines were associated with improved asthma morbidity outcomes as measured by nurse rankings of routines.

PRACTICE IMPLICATIONS

Assisting families to establish routines may result in improved asthma morbidity outcomes.

A concept analysis of routine: relevance to nursing

AIM

This paper reports a concept analysis identifying the attributes, antecedents and consequences of the concept of routine and examining the implications and applications of this concept in the field of nursing.

BACKGROUND

Routine may be a pivotal concept in understanding functional adaptation and wellbeing. Nurses in institutional settings work according to scheduled routines, patient care is largely orchestrated in routines set by organizations and regulations, and persons receiving care have their own life routines determining identity, capacities and frame of reference. However, to date, nursing has paid little attention to the relevance of routine and the role it may play in patient care.

METHOD

A concept analysis was conducted using Rodgers' guidelines. The literature search was based on the following databases: PsycInfo, CINAHL, MedLine, Social Services, and Social Work abstracts. To be included in the analysis, papers had to relate directly and essentially to the concept of routine. Seventy-four papers published from 1977 to 2005 were included in the final stage of the analysis. The analysis included target populations, disciplinary perspectives, type of manuscript, themes and definitions, theoretical models, antecedents and consequences, as well as related terms.

RESULTS

Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) and is used to organize and coordinate activities along different axes of time, duration, social and physical contexts, sequence and order. It emerges from the literature as a strategy that serves adaptation, in general, especially in the face of change and stressful situations. The conceptual structure, relations with other concepts, antecedents and consequences are described.

CONCLUSION

The concept of routine is ill-defined and seldom used in the field of nursing, despite the promise it may hold for a better understanding of a wide range of health-related issues. This concept analysis offers an integrative view of routine and suggests directions for future research and practice.

Occupational therapy intervention to foster goal setting skills for homeless mothers

SUMMARY Occupational therapy intervention was provided to two mothers living in a homeless shelter to foster goal setting skills and the ability to develop a systematic method to meet those goals. The Model of Human Occupation (MOHO) was used as the theoretical framework to guide intervention. Both mothers were able to establish personal goals and work towards meeting those goals but the outcomes varied. The difference in outcomes between the two mothers is described using MOHO with analysis of how occupational therapy services can be used with homeless mothers.

Describing the phenomenon of homelessness through the theory of occupational adaptation

SUMMARY The purpose of this study was to illustrate the value of the theory of Occupational Adaptation (Schkade & Schultz, 1992; Schultz & Schkade, 1992) in describing the phenomenon of homelessness. Case studies portray the experience of four individuals residing in a homeless shelter. Utilizing Occupational Adaptation to guide the assessment and intervention process, the results suggest that this theory may be useful in describing the individuals' internal adaptation process necessary to live independent and productive lives.