Date Presented 3/31/2017
This research examined meanings ascribed to daily occupations of persons experiencing homelessness. Participants used photographs to document occupations. Q-sort and one-on-one interviews were used to enrich data. Thematic outcomes highlight occupational therapy’s distinct value with this population.
Primary Author and Speaker: Carol Ann Lambdin-Pattavina
Additional Authors and Speakers: Catherine Peirce, Alexandra Marous, Cody Wipperman, Ariella Bitton, Melanie Baldzicki
PURPOSE: The new American Occupational Therapy Association (AOTA; 2017) Vision 2025 calls occupational therapy practitioners to maximize the health and wellness of all populations. Individuals who are experiencing homelessness are part of an underserved and marginalized population that often falls prey to occupational injustices such as deprivation. This research developed from a need to more closely examine the daily occupational experiences of homeless people in order to enhance meaningful occupational engagement and participation via occupational therapy programming. Specifically, this research sought to answer the question, What are the meanings ascribed to occupations for individuals who are currently homeless and attending a day shelter?
In Florida, where this research was conducted, there are upwards of 610,000 individuals who nightly seek some form of temporary shelter. Many are chronically homeless and attend shelters daily. While these shelters provide basic needs such as food, toiletries, and clothing, other human needs, such as participation in occupations that address psychoemotional, social, physical, and spiritual needs, are typically lacking. The researchers sought to better understand the nature of meaningful daily occupations in this population. The results will be used to drive thinking about future programming.
DESIGN: This phenomenological study used photographs to capture daily occupations that the participants deemed meaningful. Participants were recruited from a local day shelter and had to be over age 18, willing to participate in the study, fluent in English, and able to operate a disposable camera; in addition, they had to have attended the shelter a minimum of 1×/mo to be included in the study.
METHOD: Institutional review board approval was obtained. Participants were asked to photograph meaningful daily occupations. A drop box was placed at the shelter, and once returned, the photographs were developed. A follow-up interview regarding the photographs and meanings ascribed was conducted with each participant. The interviews were audio taped, and two researchers were present for each interview so that field notes could be taken. Using a Q-sort method, participants were asked to categorize the pictures based on areas of occupation from the Occupational Therapy Practice Framework (AOTA, 2014). Participants selected the five most meaningful photographs and discussed their selections. Data analysis included hand coding and subsequent development of themes.
RESULTS: A total of 27 individuals consented to participate in the study, and of the 27 cameras distributed, five were returned. Themes derived were based on both the researchers’ and the participants’ perspectives. Themes developed based on the researchers’ perspectives of the photos included social belongingness, centrality of narrative, and need for rest and sleep. Themes derived from participants’ perspectives included taking care of self and place of one’s own/privacy. Overlapping themes included a desire for normalcy and a need for resources, safety, and leisure. Of particular note is that many of the photographs that the participants categorized as self-care included activities such as praying, listening to music, and viewing art.
CONCLUSION: Results indicate that full immersion in the homeless culture is crucial to avoid bias and to understand the unique meanings ascribed to their everyday occupations. In order to facilitate full participation of choice, occupational therapy practitioners must develop effective solutions to long-standing community and population-based challenges such as homelessness. Our presence with underserved and marginalized individuals must be increased, and we must place intentional energy on maximizing the health of all people regardless of their economic status.
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006
American Occupational Therapy Association. (2017). Vision 2025. American Journal of Occupational Therapy, 71, 7103420010. https://doi.org/10.5014/ajot.2017.713002
Herzberg, G. L., Ray, S. A., & Miller, K. S. (2006). The status of occupational therapy: Addressing the needs of people experiencing homelessness. Occupational Therapy in Health Care, 20(3–4), 1–8. https://doi.org/10.1080/J003v20n03_01
Mizock, L., Russinova, Z., & Shani, R. (2014). New roads paved on losses: Photovoice perspectives about recovery from mental illness. Qualitative Health Research, 24, 1481–1491. https://doi.org/10.1177/1049732314548686
Petrenchik, T. (2006). Homelessness: Perspectives, misconceptions, and considerations for occupational therapy. Occupational Therapy in Health Care, 20(3-4), 9–30. https://doi.org/10.1080/J003v20n03_02
Thomas, Y., Gray, M., & McGinty, S. (2011). A systematic review of occupational therapy interventions with homeless people. Occupational Therapy in Health Care, 25(1), 38–53. https://doi.org/10.3109/07380577.2010.528554
