This March marks the 2 year anniversary since the onset of COVID-19. The pandemic has had long lasting effects on the health and well-being of all Canadians, and individuals experiencing homelessness are no exception. COVID-19 has placed a spotlight on the issue of homelessness in Canada by showing that individuals without safe housing options have been disproportionately affected, and the ongoing struggles of these individuals have been intensified since the pandemic. March is also homelessness awareness month, and NCCO wants to discuss some of the challenges associated with insecure housing situations and the role that occupational therapists (OTs) can play in navigating these challenges with clients that are experiencing homelessness.
Approximately 235,000 Canadians experience homelessness each year, which includes individuals who are living on the streets or are “hidden” homeless and may be temporarily staying with friends/family or living in other insecure housing accommodations (Raising the Roof, 2022). Although the root cause of homelessness is linked to poverty, there are many other underlying issues contributing to homelessness including poor physical/mental health, violence/abuse in the home, lack of income/employment, and a shortage of affordable housing available (Raising the Roof, 2022).
As OTs, we are taught to look at a client holistically and have a unique way of considering the whole individual to determine how health conditions and social factors might influence an individual’s ability to perform activities that they need, want, or are expected to do in their daily lives. Some of the main areas our OT’s might focus on during our time with clients include: supporting an individual to increase meaningful engagement in activities, supporting optimal performance in daily activities, and meaningful engagement in activity to promote cognitive, physical, and psycho-social well-being (Marshall et al, 2020). This holistic lens is important when working with clients experiencing homelessness, as there are often a number of barriers that may impede a client’s ability to meaningfully engage and partake in daily activities.
At NCCO, we work with individuals experiencing homelessness that are faced with a plethora of challenges that impact their daily activities. These challenges can include, but are not limited to, decreased access to health care services, lack of financial, social, and cultural support and resources, limited access to basic needs such as clean water and food, and limited access to environments that maintain physical and emotional safety. In our sessions, we do our best to support our clients with setting goals and addressing some of the challenges they are experiencing. These support strategies can take place at the level of the individual, community, or population. Below are some common goals and/or strategies that come up in sessions, according to various levels of intervention (and are consistent with priorities identified by individuals with lived experience of homelessness):
Individual
Engagement in meaningful activity. Boredom has been identified as a serious issue impacting the mental well-being of individuals experiencing homelessness (Marshall et al, 2020). In working with clients, we might identify various strategies to establish routine and structure to a client’s day or support them in accessing individual or group-based activities consistent with their interests.
Life skills and task support. Many clients experiencing homelessness have a lack of support and resources to engage in daily life tasks. Daily life skills and tasks that we might work with clients on in sessions include food and nutrition management, financial management, pre-vocational skills training, and self-care and hygiene management.
Adaptation of environment. Although a client’s living environment might be unstable, as community OT’s, it’s important to adapt their current environment when possible to reduce the risk of or address current injuries.
Community
Navigating the healthcare system. Many clients experiencing homelessness have had little to no contact with the healthcare system, largely due to lack of accessibility. As OTs working in the community, we have a unique role in working with clients to support them in the process of navigating the challenges and complexities of our healthcare system, including providing support in filling out paperwork and appointment management.
Establishing a sense of community. This can be a challenge when the life of individuals experiencing homelessness can be quite transient. As OTs, we can provide encouragement and support to building and maintaining positive social connections with friends and other members in their community.
Employment or education-related support. Many clients experiencing homelessness have expressed a desire to obtain education or employment but find the barriers overwhelming. With clients, we can explore interests and assist with development of skills necessary for employment/education.
Population
Advocacy efforts. As OTs, we have the opportunity to advocate for those individuals experiencing homelessness and influence public policy decisions that impact our community and those within it.
References
Marshall, C., Gewurtz, R., Barbic, S., Roy, L., Lysaght, R., Ross, C., Becker, A., Cooke, A. & Kirsh, B. (2020). Bridging the Transition from Homeless to Housed: A Social Justice Framework to Guide the Practice of Occupational Therapists. Accessed at https://www.sjmhlab. com/publications
Raising the Roof (2022). What is Homelessness. https://raisingtheroof.org/what-is-homelessness/