Evidence for your Practice: Occupational Therapy Interventions in the Transition from Homelessness

Article:  Marshall, C. A., Boland, L., Westover, L., Isard, R. & Gutman, S. (2021). A systematic review of occupational therapy interventions in the transition from homelessness. Scandinavian Journal of Occupational Therapy, 28(3), 171-187.

Rationale: Occupational therapy has a growing role in working with populations experiencing homelessness. While research exists around occupational experiences and occupation-based interventions for homeless persons, few studies have explored these same experiences and interventions during the transition from homelessness to being housed. This study aimed to evaluate the quality of current evidence around occupational therapy interventions that support the transition to housing following homelessness.

Method: Researchers conducted a systematic review of existing literature evaluating occupational therapy interventions that support the transition from homelessness to being housed. Eleven studies were included in the review, all of which were conducted in the United States between 2004 and 2018. 

Results: 

• Life skills are important to address when supporting homeless populations to transition to housing. Many people experiencing homelessness expressed concern about their ability to return to activities associated with being housed, as many had never learned these skills or needed more support around them due to mental illness or cognitive challenges. Positive outcomes of life skills interventions included improved knowledge and confidence in independent living skills; reduced trauma symptoms; and improvements in goal attainment, activity performance and satisfaction, social skills, quality of life, and housing and community functioning 

• A persistent challenge for many is a lack of opportunity to engage in meaningful occupations, resulting in boredom and negatively impacting mental wellness. As such, interventions that address barriers to engaging in meaningful activities and support the same are equally as important as interventions teaching life skills. These interventions may positively impact tenancy sustainment, goal attainment, mental health, substance use, and a perceived sense of belonging, which are key outcomes for OT interventions with people experiencing homelessness.

• Few interventions reviewed targeted increasing access to employment for individuals leaving homelessness. Employment is an important activity for most adults, and has the potential to improve community and social inclusion and reduce poverty, which is important for prevention of homelessness. Existing employment interventions for people experiencing homelessness have been explored and have been found to be effective in interdisciplinary literature. 

Conclusion: OTs play an important role in supporting individuals in the transition from homeless to housed. Existing interventions from other disciplines working with individuals transitioning from homelessness to housing focus largely on tenancy sustainment. However, interventions which address function and performance of life skills as well as barriers to engagement in meaningful activities have potential support this population to truly thrive. Study authors recommend that occupational therapists working with this population continue to develop and evaluate interventions that target both the development of life skills and engagement in meaningful occupation.

Implications for OT: 

• OTs working with people transitioning from homelessness to housing should consider using interventions that address and enable engagement in meaningful occupations, and using standardized measures of meaningful activity engagement to evaluate the effectiveness of interventions. 

• Interventions targeting engagement in meaningful activities should be used in conjunction with interventions targeting function life-skill development in order to support formerly homeless individuals to thrive in the transition to housing

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