Date Presented 03/28/20
Instrumental Activities of Daily Living skill development and stress management are positively correlated with success in the employment setting. This research focused on young adults who had aged out of the foster-care system and who had a history of homelessness and trauma. Programming measured the impact of pre–post group-based OT on facilitating progress toward employment-related goals while decreasing perceived stress levels. Results showed positive clinical significance trending toward statistical significance.
Primary Author and Speaker: Josephine Beker
Additional Authors and Speakers: Tina DeAngelis
Contributing Authors: Nitasha Rivera
PROPOSAL: The primary objective was to examine the effect of an occupational therapy educational training group on the employment-related goal achievement of young adults who have aged out of the foster-care system and who have a history of chronic homelessness and trauma. Unstable employment patterns among such youth, their lower incomes and periods of unemployment longer than the national average, are widely documented (Stewart, Kum, Barth, & Duncan, 2014). A secondary objective was to explore perceived stress levels, pre-post group programming. Research suggests that while vocational training programs offer vocational and clinical services (Poremski, Rabouin, & Latimer, 2017), there is no specific focus on IADL areas, which are identified as contributing to the poor employment outcomes of young adults (Muñoz, Reichenbach, & Hansen, 2005; Stewart et al., 2014; Thomas, Gray, & McGinty, 2011).
DESIGN: A quantitative methodology was used for this eight-week occupational therapy educational training group aimed at decreasing perceived stress levels and facilitating progress towards employment-related goals. Participants were recruited via purposive and convenience sampling from young adults who were enrolled in an apprenticeship program organized by a non-profit organization where the study was conducted. Inclusion criteria included: aged between 20-24 years, history of chronic homelessness, history of trauma, aged-out of the foster care system, resided in permanent supported housing.
METHOD: The PSS-10 and GAS were used to monitor change as a result of the group protocol, with the PSS-10 used as a pretest-posttest assessment. Demographic data were analyzed using mean, standard deviation and percentage. The mean scores on the PSS-10, as well as for itemized questions, were compared using a Wilcoxon signed-rank test to determine statistical significance at a p-value of ≤ 0.05. Median PSS-10 scores were also analyzed and evaluated for clinical significance. To analyze goal achievement, participant GAS scores were presented in a bar graph that delineated progress made from baseline at -2. SPSS Version 25 was used to analyze all results and data was reviewed by a research coordinator for accuracy.
RESULTS: Results indicated that the specifically designed 8-week group protocol positively impacted participants’ progress towards their personalized employment-related goals. Through review of their individual GAS, 100% of the participants reported positive progress towards goals, with 7 of 8 participants surpassing their expected outcome. 7 of 8 participants also saw a positive change in their PSS-10 scores; only one participant reported an increase in perceived stress levels. Mean PSS-10 scores showed a stress reduction from 18.250 pre to 11.625 post. A Wilcoxon signed-rank test showed no statistically significant change in participants’ PSS-10 scores although there was a clear trend towards significance (Z=-1.689, p=0.091).
CONCLUSION: Findings were consistent with previous studies on occupational therapy intervention with the homeless population (Muñoz et al., 2005; Thomas et al., 2011), suggesting that occupational therapy can be a beneficial component of service provision models in community-based sites. However, the small convenience sample limits the generalizability and significance of the results. Clinical significance supports the inclusion of occupational therapy in these community-based settings and its positive impact in these desired areas. Additionally, findings from this study may guide future research to focus on the potential for occupational therapy with the young adult population, both to reduce perceived stress and to enhance IADL skills for success within the employment context.
References
Muñoz, J. P., Reichenbach, D., & Hansen, A. M. W. (2005). Project Employ: engineering hope and breaking down barriers to homelessness. Work (Reading, Mass.), 25(3), 241–252. doi:10.1177/0008417416688709
Poremski, D., Rabouin, D., & Latimer, E. (2017). A Randomised Controlled Trial of Evidence Based Supported Employment for People Who have Recently been Homeless and have a Mental Illness. Administration and Policy in Mental Health, 44(2), 217–224. doi:10.1007/s10488-015-0713-2
Stewart, C. J., Kum, H.-C., Barth, R. P., & Duncan, D. F. (2014). Former foster youth: Employment outcomes up to age 30. Children and Youth Services Review, 36, 220–229. doi:10.1016/j.childyouth.2013.11.024
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. doi:10.3109/07380577.2010.528554
