Homelessness in America

Perspectives, Characterizations, and Considerations for Occupational Therapy

Kathleen Swenso Miller, Georgiana L Herzberg, Sharon A Ray

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136445439
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Learn how to better address the needs of the homelessThe causes of homelessness are complex and varied. Homelessness in America provides an overview of the state of research on the homeless population from an occupation and societal participation perspective. This important resource explores the systems of care in which homeless services are organized, the tailoring of services to meet the needs of diverse types of homeless, the newest trends in services, and crucial funding sources. Research is comprehensively examined from an occupation-based perspective, including studies on specific issues pertaining to various homeless populations. This in-depth discussion provides a vital understanding of homelessness using a client-centered and strengths-based approach in occupational therapy. Much of the research and writings of occupational therapists who work with homeless populations has been scattered throughout various diverse publications. Homelessness in America: Perspectives, Characterizations, and Considerations for Occupational Therapy gathers into one useful volume important insights, practical strategies, and valuable research into the many challenges concerning homelessness. Various effective interventions are discussed in depth. Several leading authorities explore current issues and offer illuminating case studies, extensive reference lists, and helpful tables of funding sources.Topics in Homelessness in America include:

• results of an Internet-based survey of assessment tools used with the homeless
  
• a critical examination of the assumptions of who becomes homelessand why
  
• typologies of homelessness
  
• current trends in service delivery
  
• federal organization and sources of funding for services
  
• exploratory study of occupational concerns and goals of homeless women with children
  
• study illustrating the value of the theory of Occupational Adaptation
  
• mother-toddler interactions in transitional housing
  
• the role of occupational therapy in the youth homelessness problem
  
• homeless youths' after-school and weekend time use
  
• guiding intervention by using the Model of Human Occupation (MOHO)
  
• productive role involvement at Project Employ
  
• study on life skills interventions with effective recommendations
  
• much more

Homelessness in America is insightful, important reading for occupational therapy educators, students, practicing occupational therapists, program directors of services to the homeless, and policymakers.

The Phenomenon of Homelessness

Occupational Concerns of Women Who Are Homeless and Have Children: An Occupational Justice Critique

Betsy VanLeit, PhD, OTR/L, FAOTA
Rebecca Starrett, MOT, OTR/L
Terry K. Crowe, PhD, OTR/L, FAOTA

Betsy VanLeit is Assistant Professor, Occupational Therapy Graduate Program, University of New Mexico. Rebecca Starrett is Occupational Therapist, Albuquerque Public Schools, Albuquerque, NM. Terry K. Crowe is Professor and Director, Occupational Therapy Graduate Program, University of New Mexico.

Address correspondence to: Terry K. Crowe, Occupational Therapy Graduate Program, Health Sciences Center, MSC09 5240, 1 University of New Mexico, Albuquerque, NM 87131(E-mail: [email protected]).

SUMMARY. The purpose of this exploratory study was to describe the occupational goals and concerns of women who are homeless with children. Twenty-seven women with children living in homeless shelters completed interviews using the Canadian Occupational Performance Measure (COPM). Occupational issues and concerns were identified for each participant, and then they were pooled. A total of 169 occupational concerns were described and analyzed. The most common occupational issues identified by participants concerned finances, employment, education, transportation, housing, time for self, personal appearance, home management, and parenting. Analysis of identified occupational concerns suggests that the homeless women with children experienced a range of institutional and social barriers to occupational participation: essentially a form of occupational injustice. This study raises questions concerning the most effective roles for occupational therapists to facilitate empowerment so that women who are homeless may fully participate in the communities where they live. doi:10.1300/J003v20n03_04 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2006 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Occupational therapy, participation, social justice

Introduction

Skid row, Bowery bum …once upon a time these were the places and names symbolic of homelessness in the United States. During the 1950s, women accounted for only 3% of the homeless population (Rossi, 1990). Until the 1970s most of the homeless population in the United States were transient men who followed construction and industrial development across the country and then returned to low-rent sections of cities when work was scarce(Burt, Aron, Lee, & Valente, 2001). But all of that started changing by the1970s when families began to appear in shelters and organizations that had previously served single adults. By the 1980s, families with children emerged as one of the fastest growing and largest segments of the homeless population (Nunez & Fox, 1999; Bassuk etal., 1996). Toward the late 1990s, women and single mothers with children accounted for 40% of people who were homeless (U.S. Conference of Mayors, 2001), and 85% of homeless families were headed by single women (Roth & Fox, 1990). Factors associated with these demographic changes include welfare reforms, domestic violence, drug abuse, and the demise of low-income housing (Bassuk et al., 1997).

In recent years, occupational therapists have worked with people who are homeless (Finlayson, Baker, Rodman, & Herzberg, 2002; Herzberg & Finlayson, 2001; Schultz-Krohn, 2004; Kavanagh & Fares, 1995; Mitchell & Jones, 1997), including subpopulations of homeless women with post-traumatic stress disorder (Davis & Kutter, 1998) and homeless men and women in emergency shelters (Tryssenaar, Jones, & Lee, 1999). Several authors have described introducing occupational therapy students to fieldwork with homeless individuals (Heubner & Tryssenaar, 1996; Finlayson, Baker, Rodman, & Herzberg, 2002; Drake, 1992).

Since women have become a dominant subgroup of the homeless population, this study focused on women who are homeless and have children. We wanted to describe the women’s experience in terms of the impact of homelessness on perceptions of occupational performance and participation. Ultimately, the intent is to help clarify an appropriate framework for occupational therapy practitioners to work with homeless populations that enhances client-centered practice and occupational participation outcomes.

Methods

Participants

Twenty-seven women who were homeless and had children living with them were recruited to participate in the study. Homelessness was defined as having no stable residence for at least one week. Women who met study inclusion criteria were 18 years or older, had at least one of their children living with them, spoke and understood English, were living in a temporary (shelter) housing arrangement, and voluntarily agreed to participate in the study. The study took place in a large southwestern city in the United States.

Four (15%) of the participants were recruited through a local homeless shelter for women and children. The shelter has a capacity of 15 women plus 10 children, and permits them to stay for a maximum of three weeks. A large percentage of women who come to stay at this shelter have personal histories of domestic violence. During their time at the shelter, the women are assisted by a case manager.

Twenty-three (85%) of the women were residing in a women’s shelter that specifically provided temporary housing to women and their children who are survivors of domestic violence. The residents can stay in this shelter for a maximum of 90 days. The shelter has a capacity of 100 women and their children.

Participant demographics are described in Tables 1 and 2. Table 1 includes information on the women’s age, ethnicity, grade completed in

TABLE 1. Participant Demographics (n = 27 women)

Characteristic	n	(%)
Age in Years
18-20	1	(3)
21-25	4	(15)
26-30	5	(19)
	10	(37)
36-40	3	(11)
41-45	4	(15)
Ethnicity
White/Non-Hispanic	14	(52)
Hispanic	12	(44)
Native American	4	(15)
African American	1	(4)
Other	2	(7)
Level of Education
Did not complete high school	14	(52)
Completed high school	9	(33)
Completed some college	4	(15)
Number of Children with Women
1	9	(33)
2	10	(37)
3	3	(11)
4	5	(19)
Age of Children in Years (n = 58 children)
0-2	11	(19)
3-5	11	(19)
6-8	11	(19)
9-11	13	(22)
12-14	7	(12)
15-13	4	(7)
Over 18	1	(2)
Partner Status
Identified self as single parent	23	(85)
Identified having a partner	4	(15)

TABLE 2. Participant Housing and Economic Characteristics (n = 27 women)

Characteristic	n	(%)
Type of Housing Lived in Prior to Becoming Homeless
Apartment	11	(40)
House	13	(48)
Mobile Home	1	(4)
Hotel	1	(4)
None identified	1	(4)
Monthly Income (current)
None	2	(7)
$1-$200	4	(15)
$201-$500	10	(38)
$501-$800	7	(26)
Over $800	3	(11)
Preferred not to say	1	(3)
Reported Length of Time at Current Location
Less than 2 weeks	8	(29)
3-4 weeks	3	(11)
1-3 months	9	(34)
Unsure	7	(26)
Length of Time Homeless in Lifetime
1-4 weeks	13	(49)
1-3 months	5	(19)
3-6 months	3	(10)
6 months-1 year	1	(4)
1 to 2 years	2	(7)
Over 2 years	3	(11)

school, number of children living with them, and partner status. Table 2 describes the participants’ status in terms of prior housing, economic status, and amount of time spent being homeless.

Instrument

We used the Canadian Occupational Performance Measure[COPM] (Law et al., 1998) as our interview tool. Since its inception over a decade ago, the COPM has been used and evaluated widely in research, practice and education (see for example McColl et al., 1999; Ripat, Etcheverry, Cooper, & Tate, 2001; Toomey, Nicholson, & Carswell, 1995). The COPM’s psychometric properties have been evaluated favorably for content, criterion and construct validity (Chan & Lee, 1997; McColl et al., 1999).

Essentially the COPM provided a semi-structured interview format to ask the women about their occupational concerns and issues as well as their perceptions of their current occupational performance and satisfaction. The interview format divides occupational issues into the areas of “Self-Care,” “Productivity” and “Leisure,” areas consistent with occupational performance areas in the Canadian Model of Occupational Performance [CMOP] (Canadian Association of Occupational Therapists, 1997), and in fact the COPM was designed as an assessment tool that could be used with the CMOP as a guiding model. The CMOP describes the factors that are important to creation of occupation, and its sister model, the Person-Environment-Occupational Model (PEO) emphasizes attention to the fit of the component parts (person, occupation and environment) to optimal occupational performance (Canadian Association of Occupational Therapists, 1997).

Procedures

After receiving University of New Mexico Human Research Review Committee approval, an experienced occupational therapist and researcher (the first author) trained two researchers (occupational therapy graduate students) to collect participant data. After successful pilot testing and finalization of procedural reliability, participants were recruited from the two shelters. The first author observed every fifth interview to assure that the data collectors continued to follow consistent interview procedures throughout the study.

With guidance from the shelter managers, shelter staff and case managers recruited the women, arranged interview times, provided private interview space for the researchers, and introduced the researchers to the women who agreed to participate. After establishing initial rapport, the researchers introduced the consent form which was then read, discussed and signed before initiating the interview. In addition to gathering demographic data and completing the COPM, the researchers also collected time use data for each participant. The results of the time use component of the investigation are reported elsewhere (Kroening, 2002). Each interview was audiotaped and researchers took written notes as well, including actual quotes from the women while filling out the COPM form. Interviews lasted from one to two hours, and after completion, each participant was given a gift certificate to thank her for her time.

Data Analysis

Data were analyzed using descriptive statistics. For demographic data we determined frequencies. For COPM occupational concerns, we listed all of the occupational concerns and then grouped similar ones together (e.g., all occupational concerns about needing to obtain employment were counted together). This allowed us to then characterize types of occupational concerns, as well as frequencies of types of concerns. We also qualitatively used actual quotes from participants to better illustrate occupational concerns.

Results

Participants identified multiple occupational concerns for a pooled total of 169 issues. Table 3 lists the occupational concerns identified by the women in descending order of frequency.

In addition to identifying occupational issues, participants were asked to rate them for importance on a scale of 1-10 (1 being unimportant and 10 being extremely important). The mean rating was 8.62, indicating overall high importance of occupational concerns that were listed.

The greatest number of concerns listed had to do with inadequate finances. The women described issues that ranged from worrying about not having enough money to pay for living expenses, to concerns about saving money for the future, to actually obtaining control over family finances at all (some women were currently separated from husbands or partners who had control over financial resources).

The next most common concern revolved around employment. Issues included being unemployed, being underemployed, needing a job that allowed for flexible scheduling, and having work that paid adequately to support a family. One woman stated: “It’s hard for me to get a job, but I want to be in the right job, in the right place.”

Educational concerns came next in order of frequency. Women identified concerns about their lack of education, and this was often reported in association with their lack of adequate employment. In the words of one woman: “Staying in school is my way out of this life …”

TABLE 3. Identified COPM Concerns (n = 169)

Type of Concern	n
Finances	18
Employment	16
Education	15
Transportation	15
Housing	14
Time for Self	13
Personal Appearance	10
Home Management	10
Care of Children/Parenting	10
Spending more Time with Children	9
Family/Friend Support	7
Safety	7
Childcare (by other Adults)	6
Time in Community with Children	5
Sobriety	5
Spirituality	4
Issues with Shelter Rules/Staff	2
Travel/Vacation	1
Sleep	1

Transportation concerns were also common as many of the participants in the study did not own their own vehicle or have access to a car. Many women reported needing a vehicle to go to work, school or appointments, and they perceived public transportation as inadequate (several women stated that it could take hours to accomplish one appointment across town using the bus).

Not surprisingly, quite a few women voiced concerns about housing. However, it is interesting that this was not identified more often given that all of the women were currently homeless. The words: “I’d like to have a place of my own” were spoken by a number of women. They expressed frustration with the paucity of assista...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• OVERVIEW
• THE PHENOMENON OF HOMELESSNESS
• APPLICATION
• Index