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Marshall CA, Cooke A, Gewurtz R, Barbic S, Roy L, Ross C, Becker A, Lysaght R, Kirsh B. Bridging the transition from homelessness: Developing an occupational therapy framework. Scand J Occup Ther 2023; 30:953-969. [PMID: 34582719 DOI: 10.1080/11038128.2021.1962970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Occupational therapists support individuals experiencing homelessness in traditional roles, and occupational therapy positions focussed specifically on homelessness appear to be growing. OBJECTIVES To develop and refine a framework to guide occupational therapy practice and research in homelessness. METHOD We developed a framework and refined it through a stakeholder consultation process conducted with 17 international occupational therapy experts using an online survey. In this survey, we presented an initial framework and requested qualitative feedback. We analyzed this qualitative data using content analysis. RESULTS Stakeholder feedback was categorized into eight recommendations: (1) Revision to the 'four processes'; (2) Emphasizing social justice and systems-level advocacy; (3) Reflecting intersectionality; (4) Emphasizing meaningful activity; (5) Emphasizing peer support; (6) Incorporating a focus on independent living skills; (7) Increasing a focus on an activity for addressing substance misuse; and (8) Acknowledging cognitive and physical health. Each of these recommendations was incorporated into a refined version of this framework. These recommendations and a refined version of the framework are presented in this paper. CONCLUSIONS We have developed and refined a framework aimed at guiding practice and research in occupational therapy in homelessness that will be evaluated in future research. SIGNIFICANCE Though a range of frameworks exists for guiding the practice of occupational therapists more generally, this framework represents the first that is focussed specifically on guiding occupational therapy practice and research with individuals who experience homelessness. Research and practice implications are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- School of Occupational Therapy, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Abrial Cooke
- School of Occupational Therapy, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, Faculty of Medicine, Vancouver, Canada
| | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Caitlin Ross
- Community Mental Health Services, Vancouver Island Health Authority, Victoria, Canada
| | - Alyssa Becker
- School of Occupational Therapy, Queens University, Dhaka, Bangladesh
- VHA Home Healthcare London, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Pilla D, Park-Taylor J. "Halfway Independent": Experiences of formerly homeless adults living in permanent supportive housing. J Community Psychol 2022; 50:1411-1429. [PMID: 34561888 DOI: 10.1002/jcop.22724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/05/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Permanent supportive housing (PSH), which combines affordable public housing with social services, has become the dominant model in the United States for providing housing to formerly homeless people. PSH has been effective in reducing re-entry to homelessness, yet has shown limited evidence of improving formerly homeless individuals' mental health and quality of life. This study aimed to understand the lived experiences of formerly homeless adults' adjustment to tenancy in PSH, with a focus on how living in PSH has affected their meaningful activity and social engagement. Based on a phenomenological approach, a thematic analysis was conducted using semi-structured interviews with 17 individuals living in three PSH buildings in New York City. Results suggested that PSH was beneficial in fulfilling formerly homeless individual's basic needs and facilitating lifestyle improvements, yet many were dissatisfied with their living conditions and lacked meaningful activity, social integration, and community belongingness. These issues were found to develop in large part as a result of formerly homeless individuals' disharmonious relationships within the social context of PSH, consisting of staff members, other residents, and people in the surrounding community. The effects of the COVID-19 pandemic and implications for PSH social services are discussed.
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Affiliation(s)
- David Pilla
- Division of Psychological and Educational Services, Department of Counseling Psychology, Graduate School of Education, Fordham University, New York City, New York, USA
| | - Jennie Park-Taylor
- Division of Psychological and Educational Services, Department of Counseling Psychology, Graduate School of Education, Fordham University, New York City, New York, USA
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Tyminski QP, Drummond RR, Heisey CF, Evans SK, Hendrix A, Jaegers LA, Baum CM. Initial Development of the Activity Card Sort-Advancing Inclusive Participation from a Homeless Population Perspective. Occup Ther Int 2020; 2020:9083082. [PMID: 32694959 PMCID: PMC7355358 DOI: 10.1155/2020/9083082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/30/2020] [Indexed: 11/27/2022] Open
Abstract
METHODS Develop a new version of the Activity Card Sort-Advancing Inclusive Participation to include occupations experienced by the homeless population, including nonsanctioned occupations. This study occurred in two phases: (1) tool development (item selection, content expert review, line development drawing, and assessment of content validity) and (2) tool use to determine face validity. Participants were selected through a convenience sample at a local homeless shelter and academic institution. Participants experiencing homelessness (phase 1: N = 13, phase 2: N = 10) were required to be seeking services at the homeless shelter, while nonhomeless participants (phase 2: N = 30) worked full-time, resided with a significant other, and had personal transportation. RESULTS An assessment of 76 occupations, corresponding line drawings, and follow-up questions was created. An initial construct validity study demonstrated differences between occupational participation of those who are homeless and nonhomeless in the areas of social engagement, nonsanctioned occupations, work and education, and home management. Both groups reported previous, current, or desired engagement in the occupations identified in the assessment. Conclusions and relevance. The purpose of this study was to create an inclusive assessment for use in the homeless population and complete a construct validity study of the assessment tool. Although the results indicated some differences in the frequency with which occupations were performed, the results demonstrated that all individuals participate in occupations that many not contribute to their health and wellness. This initial work supports the future development of a tool that is inclusive of all occupations to obtain a holistic picture of an individual's participation.
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Affiliation(s)
- Quinn P. Tyminski
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ronald R. Drummond
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Claire F. Heisey
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shelby K. Evans
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Audra Hendrix
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa A. Jaegers
- Department of Occupational Science and Occupational Therapy, Saint Louis University, St. Louis, Missouri, USA
| | - Carolyn M. Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Marshall CA, Boland L, Westover LA, Isard R, Gutman SA. A systematic review of occupational therapy interventions in the transition from homelessness. Scand J Occup Ther 2020; 28:171-187. [PMID: 32476575 DOI: 10.1080/11038128.2020.1764094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE Implications for research and practice are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | | | - Roxanne Isard
- Faculty of Information & Media Studies & the Faculty of Social Sciences, Allyn & Betty Taylor Library, Western University, London, ON, Canada
| | - Sharon A Gutman
- Programs in Occupational Therapy, Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Fieldhouse J, Greatorex H. Evaluation of a financial skills training programme for vulnerable young people at risk of homelessness. Br J Occup Ther 2020. [DOI: 10.1177/0308022620905530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction A financial skills training programme (Cash Pointers) for young people at risk of homelessness had an unexpectedly positive impact on their wellbeing. A qualitative inquiry examined this phenomenon. Method Interviews with six trainees explored their experiences of the programme. A focus group comprising four programme workers added a service provider perspective. Findings Cash Pointers addressed trainees’ basic living and health needs. Additionally, trusting relationships with programme workers enabled trainees to feel safe, develop skills, pursue goals, manage health problems, improve relationships and engage in life roles. Trainees said Cash Pointers was accessible and responsive, offering advocacy, inter-agency liaison and hope. Programme workers said they balanced the need for quick results with patient relationship-building, were a well-supported team with a high degree of casework autonomy and felt skilled in the therapeutic use of self. Conclusion Cash Pointers created a psychologically informed environment within which trainees stabilised, acquired skills and progressed towards greater life satisfaction and inclusion. Improving financial skills can be profoundly transformative and an acceptable intervention for this population. Aspects of occupational therapy’s knowledge-base (dynamic systems thinking) and skillset (person-centred goal-setting, therapeutic use of self, creating enabling environments) can support this.
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Affiliation(s)
- Jon Fieldhouse
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Carver H, Ring N, Miler J, Parkes T. What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduct J 2020; 17:10. [PMID: 32005119 PMCID: PMC6995160 DOI: 10.1186/s12954-020-0356-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group. Methods Meta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases (CINAHL; Criminal Justice Abstracts; Health Source; MEDLINE; PsycINFO; SocINDEX; Scopus; and Web of Science) and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically. Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original over-arching line-of-argument and conceptual model. Results Twenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services. Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women. From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user’s perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people’s lives. Conclusion This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted. The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals’ complex lives.
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Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Nicola Ring
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Joanna Miler
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Marshall CA, Boland L, Westover LA, Wickett S, Roy L, Mace J, Gewurtz R, Barbic S, Kirsh B. Occupational experiences of homelessness: A systematic review and meta-aggregation. Scand J Occup Ther 2019; 27:394-407. [DOI: 10.1080/11038128.2019.1689292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | | | - Sarah Wickett
- Bracken Health Sciences Library, Queen’s University, Kingston, Canada
| | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Jenni Mace
- Department of Occupational Science and Therapy, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, Faculty of Medicine, Vancouver, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Malfitano APS, de Souza RGDM, Townsend EA, Lopes RE. Do occupational justice concepts inform occupational therapists' practice? A scoping review. Can J Occup Ther 2019; 86:299-312. [PMID: 31013142 DOI: 10.1177/0008417419833409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Occupational justice and related concepts can inform practices directed at injustice and the lack of rights in daily life. Brazilian ideas about social occupational therapy seem to be similar to these concepts about inequality. PURPOSE. This study aimed to answer the questions, "Do occupational justice concepts inform occupational therapists' professional actions?" and "How are occupational justice concepts connected to Brazilian ideas about social occupational therapy?" METHOD. A secondary analysis was undertaken of a scoping review using occupational justice and related concepts as keywords. Descriptive and categorical analyses were used to classify the extract data. FINDINGS. We selected 42 articles that specify occupational therapy practices, classified as individual approaches (n = 13), individual-integrated-with-social approaches (n = 22), and social approaches (n = 7). It was found that occupational justice concepts have informed individual approaches and that the second and third approaches can be connected with social occupational therapy. IMPLICATIONS. Dialogue for sharing knowledge, concepts, and practices of occupational therapy worldwide can be inspired by this review.
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Marshall CA, Davidson L, Li A, Gewurtz R, Roy L, Barbic S, Kirsh B, Lysaght R. Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study. Can J Occup Ther 2019; 86:357-370. [PMID: 30987447 DOI: 10.1177/0008417419833402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being. PURPOSE. This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons. METHOD. A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation. FINDINGS. Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r s = -.771, p < .01) were identified. IMPLICATIONS. Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.
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Marshall CA, Lysaght R, Krupa T. Occupational transition in the process of becoming housed following chronic homelessness. Can J Occup Ther 2018; 85:33-45. [DOI: 10.1177/0008417417723351] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salsi S, Awadallah Y, Leclair AB, Breault M, Duong D, Roy L. Occupational needs and priorities of women experiencing homelessness: Les besoins et priorités occupationnels des femmes en situation d’itinérance. Can J Occup Ther 2018; 84:229-41. [DOI: 10.1177/0008417417719725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Roy L, Vallée C, Kirsh BH, Marshall CA, Marval R, Low A. Occupation-based practices and homelessness: A scoping review. Can J Occup Ther 2017; 84:98-110. [DOI: 10.1177/0008417416688709] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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