What Are the Effects of Consultative Occupational Therapy Services on Homeless Adults With Serious Mental Illness?

What are the effects of consultative occupational therapy (OT) on homeless adults with serious mental illness?

Substantial evidence within OT practice demonstrates the overall effectiveness of OT intervention with individuals who are homeless and with mental illness.

The purpose of this study was to explore the effects of OT consultative services on service provider decisions regarding care and supports for clients who are homeless. Additionally, this study sought to understand the characteristics of individuals who are homeless through two established functional assessments. The long-term goal of this research is to demonstrate the efficacy of OT assessment and recommendations to support the role of OT in these settings.

The research question was addressed using both quantitative survey and qualitative methods, which is appropriate when researching complex phenomena such as homelessness, because each method contributes critical information to aid understanding. Quantitative data were collected through survey methods. Qualitative data were collected through individual in-depth interviews, which were audio recorded and transcribed verbatim.

Thirty homeless adults with serious mental illness participated in the study. All were referred by a case manager and completed the informed consent process as approved by the Institutional Review Board of Towson University and agency leadership. Four case managers also completed individual interviews about their reasons to refer and use of OT consultative findings.

Mental health providers at HCH referred clients whom they were considering referring to HCH’s Permanent Supportive Housing program. Referring providers completed a form regarding their knowledge of the client’s current functional performance on activities of daily living and instrumental activities of daily living, as well as any current supports. Each client (N = 30) participated in the full assessment, which included the Allen Cognitive Level Screen (ACLS5) and the Executive Function Performance Test. The results of the assessments were recorded in the electronic medical record with recommendations regarding support needed for successful community living. Providers utilized the results of the assessment/recommendations to support their decision to refer to a range of services and supportive housing programs.

Quantitative data about participant characteristics were summarized using descriptive statistics, including frequency distributions, mean, range, and standard deviation. Qualitative data were systematically reviewed by the researchers and employed triangulation to strengthen trustworthiness. Each transcript was reviewed independently by each researcher, to gather an overall gestalt. Then a second independent review was completed, and initial codes were identified from key words, phrases, or repeated content. The researchers then met to discuss findings until agreement on themes from transcripts. Themes were shared with interviewees as a form of member checking.

Quantitative results revealed a range in ACL–5 scores, with most in the 4.0–4.8 range, and a high degree of comorbidity with substance abuse, medical condition, and/or history of head injury. Qualitative data revealed that referrers valued OT for clients with particular complexities that could be addressed through adaptations or task approach.

This study demonstrates the value of OT consultative services from the perspectives of referrers who serve homeless adults in the community. It also provides initial data on the population characteristics and how these characteristics lead to referrals for services.

This research described the functional demographics of clients who are homeless as well as the utility of OT assessments to service providers. Following initial findings, a full-time OT position was created, and many additional providers within HCH now utilize OT services for their clients. This research can be replicated in other settings.