Expanding Mental Health Occupational Therapy to Emerging Settings: Provider Perspectives

PURPOSE: Substantial evidence within occupational therapy practice demonstrates the overall effectiveness and utility of occupational therapy intervention with at-risk populations, including those who are homeless and with mental illness. Despite a long history of supporting clients with mental illness and other challenges to live successfully in the community, occupational therapists are not routinely hired into positions at shelters or primary care settings serving individuals who are homeless. The purpose of this study was to explore the effects of occupational therapy consultative services on service provider decisions relative to care and supports for clients who are homeless. The long-term goal of this research is to demonstrate the efficacy of occupational therapy assessment and recommendations in order to support the role of occupational therapists in settings that provide care to individuals experiencing homelessness and/or mental illness.

DESIGN: This aspect of the study used qualitative methods. Qualitative data were collected through individual in-depth interviews with 10 referrers who discussed their experiences with occupational therapy consultation, particularly reasons for referral and expectations and use of the consultation process.

METHOD: Interviews were audio recorded and transcribed verbatim. Data were systematically reviewed by the researchers and triangulation used to strengthen trustworthiness. Each transcript was subject to two independent reviews by each researcher, first to gather an overall gestalt, then to identify initial codes from key words, phrases, or repeated content. The researchers then met to review findings until consensus was reached and themes were identified. Themes were shared with interviewees as a form of member checking.

RESULTS: Results revealed that referrers valued occupational therapy for clients with particular complexities, such as suspected cognitive impairment or complicated mental health challenges, that could be addressed through individualized adaptations or interventions. The use of authentic contexts for assessment to verify or validate concerns about functional cognition was also highlighted.

CONCLUSION: This study demonstrates the value of occupational therapy consultative services from the perspective of referrers who serve homeless adults in the community, with particular emphasis on translating performance challenges into strategies that could be used to support engagement in daily activities. In this manner, it supports a role for occupational therapists in a community agency reflecting emerging practice.