The Experience of Occupational Transition From Homelessness to Becoming Housed

RESEARCH QUESTION: What is the experience of occupational engagement during the transition from homelessness to becoming housed?

RATIONALE: Occupational therapy is emerging as a practice role in the support of persons who are experiencing homelessness or who are transitioning from long-term homelessness to becoming housed. There is a developing literature base that focuses on occupational performance and engagement of homeless persons; however, more research is required to build an evidence base and rationale for our role in this area. In particular, there is a paucity of literature focusing on the occupational transition during the transition to becoming housed in homeless persons. This focus is unique and is needed to begin to identify future practice and research directions with this population.

DESIGN: An interpretive phenomenological research study was carried out to explore the experience of occupational transition of chronically homeless persons as they transition to becoming housed.

PARTICIPANTS: Eleven adults were purposively recruited from case management staff in housing organizations as well as through shelters and drop-in centers in a small urban center in Ontario, Canada. Representativeness was preserved by sampling persons with and without substance use or mental illness diagnoses. All participants had a history of chronic homelessness and had been housed for ≥3 mo or <2 yr. Median age was 45 yr. Mean length of housing was 12 mo. Mean length of homeless episodes prior to becoming housed was 4.2 yr.

METHOD: Participants were engaged in semistructured interviews ranging from 45 min to 3 hr, 22 min. Interviews were recorded and transcribed verbatim.

ANALYSIS: Data were organized using NVivo 10 and analyzed using the seven-step process described by Colaizzi.

RESULTS: Analysis resulted in six main themes and related subthemes. Themes include occupations to give back, resuming familiar occupations, negotiating substance use, coping with the quiet, seeing yourself differently, and the meaning of spiritual occupations. These themes suggest that participants experience an acclimatization period after the security of housing characterized by a lack of occupation initially, followed by a change in identity that informs the reengagement in a new occupational repertoire. The security of roles and responsibilities were seen as ways of moving away from a period of homelessness on a longer term basis.

DISCUSSION: This study offers a unique contribution to the developing literature base in occupational therapy as it relates to the issue of homelessness. The results offer insight into the occupational lives of chronically homeless persons as they transition to housing and are of relevance to occupational therapists (OTs) working in community settings in which they support homeless persons. Assisting chronically homeless persons develop roles and responsibilities as they transition from homelessness while maintaining a sensitivity to the changing identities that may accompany a change in one’s occupational repertoire are important findings to relate to occupational therapy practice.

IMPACT STATEMENT: OTs have an important role in addressing the problem of homelessness, and roles are currently emerging in many communities in Canada and the United States. More research to support approaches from an occupational perspective is needed. Developing this literature base further has the ability to position OTs as experts providing a perspective and response to the problem of homelessness that is unique among other professions, and one that is greatly needed in this area.