Women in unstable housing or who are homeless experience disruptions of occupational engagement and performance. Little is known about their perspective on their occupational needs and priorities.
Purpose.
This study aimed to determine how patterns of occupational engagement and performance are facilitated or hindered by personal factors and resources available to sheltered women.
Method.
A participatory, descriptive mixed-methods study design was used. Twenty-one residents were interviewed using the Canadian Occupational Performance Measure, the Goal Attainment Scale, and a time-use inventory. Nineteen residents participated in semistructured qualitative interviews. Qualitative data were analysed using interpretive description.
Findings.
Participants spent most time on sleep and passive leisure and identified occupational performance issues and goals related to active leisure and employment. Participants’ occupational lives were described as transitional journeys comprising five subthemes: seeking safety and stability, being sheltered, shaping one’s identity, developing resilience, and engaging in contemplation, contribution, and connectedness through occupation.
Implications.
Trauma-informed and strengths-based approaches are recommended for this population. Future research should study the implementation of occupation-based interventions in community settings.
AmsterR. (2008). Lost in space: The criminalization, globalization, and urban ecology of homelessness. New York, NY: LFB Scholarly Publishing.
2.
BoydellK. M.GoeringP.Morrell-BellaiT. L. (2000). Narratives of identity: Re-presentation of self in people who are homeless. Qualitative Health Research, 10, 26–38. doi:10.1177/104973200129118228
CargoM.MercerS. L. (2008). The value and challenges of participatory research: Strengthening its practice. Annual Review of Public Health, 29, 325–350. doi:10.1146/annurev.publhealth.29.091307.083824
5.
CarswellA.McCollM. A.BaptisteS.LawM.PolatajkoH.PollockN. (2004). The Canadian Occupational Performance Measure: A research and clinical literature review. Canadian Journal of Occupational Therapy, 71, 210–222. doi:doi:10.1177/000841740407100406
6.
CatonC. L.DominguezB.SchanzerB.HasinD. S.ShroutP. E.FelixA.…HsuE. (2005). Risk factors for long-term homelessness: Findings from a longitudinal study of first-time homeless single adults. American Journal of Public Health, 95, 1753–1759. doi:10.2105/ajph.2005.063321
7.
ChambersC.ChiuS.ScottA. N.TolomiczenkoG.RedelmeierD. A.LevinsonW.HwangS. W. (2014). Factors associated with poor mental health status among homeless women with and without dependent children. Community Mental Health Journal, 50, 553–559. doi:10.1007/s10597-013-9605-7
8.
ChapleauA. (2010). Voices from the street: How structural and individual factors influence homelessness. Occupational Therapy in Mental Health, 26, 387–400. doi:10.1080/0164212X.2010.518310
9.
ChesnayC. T.BellotC.SylvestreM.-E. (2013). Taming disorderly people one ticket at a time: the penalization of homelessness in Ontario and British Columbia. Canadian Journal of Criminology and Criminal Justice, 55, 161–185.
10.
ClokeP.MayJ.JohnsenS. (2008). Performativity and affect in the homeless city. Environment and Planning D–Society & Space, 26, 241–263.
11.
CreswellJ. W.Plano ClarkV. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.
12.
DoigE.FlemingJ.KuipersP.CornwellP. L. (2010). Clinical utility of the combined use of the Canadian Occupational Performance Measure and Goal Attainment Scaling. American Journal of Occupational Therapy, 64, 904–914. doi:10.5014/ajot.2010.08156
13.
EdgelowM.KrupaT. (2011). Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. American Journal of Occupational Therapy, 65, 267–276. doi:10.5014/ajot.2011.001313
14.
EyssenI.SteultjensM.OudT.BoltE. M.MaasdamA.DekkerJ. (2011). Responsiveness of the Canadian Occupational Performance Measure. Journal of Rehabilitation Research and Development, 48, 517–528. doi:10.1682/JRRD.2010.06.0110
15.
GaetzS.DejE.RichterT.RedmanM. (2016). The state of homelessness in Canada 2016. Toronto, ON: Canadian Observatory on Homelessness Press.
16.
GaetzS.DonaldsonJ.RichterT.GulliverT. (2013). The state of homelessness in Canada 2013. Toronto, ON: Canadian Homelessness Research Network Press.
17.
GaetzS.GulliverT.RichterT. (2014). The state of homelessness in Canada: 2014. Toronto, ON: Homeless Hub Press.
18.
GoeringP.VeldhuizenS.WatsonA.AdairC.KoppB.LatimerE.…AubryT. (2014). National At Home/Chez soi final report. Calgary, AB: Mental Health Commission of Canada.
19.
GordeM. W.HelfrichC. A.FinlaysonM. L. (2004). Trauma symptoms and life skill needs of domestic violence victims. Journal of Interpersonal Violence, 19, 691–708. doi:10.1177/0886260504263871
20.
GutmanS. A.DiamondH.Holness-ParchmentS. E.BrandofinoD. N.PachecoD. G.Jolly-EdouardM.Jean-CharlesS. (2004). Enhancing independence in women experiencing domestic violence and possible brain injury: An assessment of an occupational therapy intervention. Occupational Therapy in Mental Health, 20, 49–79. doi:10.1300/J004v20n01_03
21.
GutmanS. A.Raphael-GreenfieldE. I.SimonP. M. (2016). Feasibility and acceptability of a pilot housing transition program for homeless adults with mental illness and substance use. Occupational Therapy in Health Care, 30, 124–138. doi:10.3109/07380577.2015.1060660
22.
HelfrichC. A.AvilesA. M.BadianiC.WalensD.SabolP. (2006). Life skill interventions with homeless youth, domestic violence victims and adults with mental illness. Occupational Therapy in Health Care, 20(3/4), 189–207.
23.
HelfrichC. A.ChanD. V. (2013). Changes in self-identified priorities, competencies, and values of recently homeless adults with psychiatric disabilities. American Journal of Psychiatric Rehabilitation, 16(1), 22–49. doi:10.1080/15487768.2013.762298
24.
HelfrichC. A.RiveraY. (2006). Employment skills and domestic violence survivors. Occupational Therapy in Mental Health, 22, 33–48. doi:10.1300/J004v22n01_03
25.
HeuchemerB.JosephssonS. (2006). Leaving homelessness and addiction: Narratives of an occupational transition. Scandinavian Journal of Occupational Therapy, 13, 160–169. doi:10.1080/11038120500360648
26.
HodgettsD.StolteO.ChamberlainK.RadleyA.NikoraL.NabalaruaE.GrootS. (2008). A trip to the library: Homelessness and social inclusion. Social and Cultural Geography, 9, 933–953. doi:10.1080/14649360802441432
27.
HopperE. K.BassukE. L.OlivetJ. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. Open Health Services and Policy Journal, 201, 80–100.
28.
HumbertT. K.BessJ. L.MoweryA. M. (2013). Exploring women’s perspectives of overcoming intimate partner violence: A phenomenological study. Occupational Therapy in Mental Health, 29, 246–265. doi:10.1080/0164212X.2013.819465
29.
HuntingtonN.MosesD. J.VeyseyB. M. (2005). Developing and implementing a comprehensive approach to serving women with co-occurring disorders and histories of trauma. Journal of Community Psychology, 33, 395–410. doi:10.1002/jcop.20059
30.
HwangS. W.WilkinsR.TjepkemaM.O’CampoP. J.DunnJ. R. (2009). Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. British Medical Journal, 339, Articleb4036. doi:10.1136/bmj.b4036
31.
IllmanS. C.SpenceS.O’CampoP. J.KirshB. H. (2013). Exploring the occupations of homeless adults living with mental illnesses in Toronto. Canadian Journal of Occupational Therapy, 80, 215–223. doi:10.1177/0008417413506555
32.
Javaherian-DysingerH.KrpalekD.HueckerE.HewittL.CabreraM.BrownC.…ServerS. (2016). Occupational needs and goals of survivors of domestic violence. Occupational Therapy in Health Care, 30, 175–186. doi:10.3109/07380577.2015.1109741
33.
KiresukT.ShermanR. (1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443–453. doi:10.1007/BF01530764
34.
KlitzingS. W. (2004). Women living in a homeless shelter: Stress, coping and leisure. Journal of Leisure Research, 36, 483–512.
35.
KrupaT.EdgelowM.ChenS.-P.MierasC.AlmasA.PerryA.…BransfieldM. (2010). Action over inertia: Addressing the activity-health needs of individuals with serious mental illness. Ottawa, ON: CAOT Publications ACE.
Laliberte-RudmanD. (2015). Situating occupation in social relations of power: Occupational possibilities, ageism and the retirement “choice.”South African Journal of Occupational Therapy, 45(1), 27–33. doi:10.17159/2310-3833/2015/v45no1a5
38.
LawM.BaptisteS.CarswellA.McCollM.PolatajkoH.PollockN. (2014). Canadian Occupational Performance Measure (5th ed.) Ottawa, ON: CAOT Publications ACE.
39.
MarshallC. A.RosenbergM. W. (2014). Occupation and the process of transition from homelessness: L’occupation et le processus de transition de l’itinérance au logement. Canadian Journal of Occupational Therapy, 81, 330–338. doi:10.1177/0008417414548573
40.
MarshallC. A.RoyL.PanterG.PhillipsB. (2015, 9). Homelessness and occupational therapy: Perspectives in supporting the transition for homeless to housed. Paper presented at the Ontario Society of Occupational Therapists Annual Conference, Kingston, ON.
41.
MartinM.SadloG.StewG. (2012). Rethinking occupational deprivation and boredom. Journal of Occupational Science, 19, 54–61. doi:10.1080/14427591.2011.640210
42.
McNaughtonC. C.SandersT. (2007). Housing and transitional phases out of “disordered” lives: The case of leaving homelessness and street sex work. Housing Studies, 22, 885–900. doi:10.1080/02673030701608043
43.
McNultyM. C.CroweT. K.KroeningC.VanLeitB.GoodR. (2009). Time use of women with children living in an emergency homeless shelter for survivors of domestic violence. OTJR: Occupation, Participation and Health, 29, 183–190. doi:10.3928/15394492-20090914-06
44.
Morrell-BellaiT.GoeringP.BoydellK. (2000). Becoming and remaining homeless: A qualitative investigation. Issues in Mental Health Nursing, 21, 581–604. doi:10.1080/01612840050110290
45.
MuñozJ. P.GarciaT.LisakJ.ReichenbachD. (2006). Assessing the occupational performance priorities of people who are homeless. Occupational Therapy in Health Care, 20(3/4), 135–148.
46.
PadgettD. K. (2007). There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States. Social Science and Medicine, 64, 1925–1936. doi:10.1016/j.socscimed.2007.02.011
47.
Panter-BrickC.EggermanM. (2012). Understanding culture, resilience, and mental health: The production of hope. In UngarM. (Ed.), The social ecology of resilience: A handbook of theory and practice (pp. 369–386). New York, NY: Springer-Verlag New.
48.
ParadisE.MosherJ. (2012). “Take the story, take the needs, and DO something”: Grassroots women’s priorities for community-based participatory research and action on homelessness. Toronto, ON: Canadian Homelessness Research Network Press. Retrieved from Homeless Hub website athttp://www.homelesshub.ca/Library/View.aspx?id=55138
49.
Raphael-GreenfieldE.GutmanS. A. (2015). Understanding the lived experience of formerly homeless adults as they transition to supportive housing. Occupational Therapy in Mental Health, 31, 35–49. doi:10.1080/0164212X.2014.1001011
50.
RayS. A. (2006). Mother-toddler interactions during child-focused activity in transitional housing. Occupational Therapy in Health Care, 20(3/4), 81–97. doi:10.1080/J003v20n03_06
51.
ReidD. (2011). Mindfulness and flow in occupational engagement: presence in doing. Canadian Journal of Occupational Therapy, 78, 50–56. doi:10.2182/cjot.2011.78.1.7
52.
RiordanT. M. (2004). Exploring the circle: Mental illness, homelessness and the criminal justice system in Canada. Ottawa, ON: Library of Parliament, Political and Social Affairs Division.
53.
RoyL.CrockerA. G.NichollsT. L.LatimerE. A.AyllonA. R. (2014). Criminal behavior and victimization among homeless individuals with severe mental illness: A systematic review. Psychiatric Services, 65, 739–750. doi:10.1176/appi.ps.201200515.
54.
RoyL.ValléeC.KirshB. H.MarshallC. A.MarvalR.LowA. (2017). Occupation-based practices and homelessness: A scoping review. Canadian Journal of Occupational Therapy, 84, 98–110. doi:10.1177/0008417416688709
55.
SandelowskiM. (2000). Whatever happened to qualitative description?Research in Nursing and Health, 23, 334–340.
56.
Schultz-KrohnW. (2004). The meaning of family routines in a homeless shelter. American Journal of Occupational Therapy, 58, 531–542.
57.
Schultz-KrohnW. (2009). Working With homeless families. OT Practice, 14(5), 19–20.
58.
Schultz-KrohnW.DrnekS.PowellK. (2006). Occupational therapy intervention to foster goal setting skills for homeless mothers. Occupational Therapy in Health Care, 20(3/4), 149–166. doi:10.1080/J003v20n03_10
59.
SchusterJ.ParkC. L.FrismanL. K. (2011). Trauma exposure and PTSD symptoms among homeless mothers: Predicting coping and mental health outcomes. Journal of Social and Clinical Psychology, 30, 887–904.
60.
SheflerG.CanettiL.WisemanH. (2001). Psychometric properties of goal-attainment scaling in the assessment of Mann’s time-limited psychotherapy. Journal of Clinical Psychology, 57, 971–979. doi:10.1002/jclp.1063
61.
StanleyM. (2014). Qualitative descriptive: A very good place to start. In NayarS.StanleyM. (Eds.), Qualitative research methodologies for occupational science and therapy (pp. 21–36). New York, NY: Routledge.
StergiopoulosV.BurraT.RourkeS.HwangS. (2011). Housing status as an independent predictor of functional capacity in patients with schizophrenia. Journal of Nervous and Mental Disease, 199, 854–860.
64.
ThibeaultR. (2011). Occupational gifts. In McCollM. (Ed.), Spirituality and occupational therapy (pp. 111–120). Ottawa, ON: CAOT Publications ACE.
65.
TolomiczenkoG.GoeringP. (2001). Gender differences in legal involvement among homeless shelter users. International Journal of Law and Psychiatry, 24, 583–593.
66.
TorchallaI.StrehlauV.LiK.Aube LindenI.NoelF.KrauszM. (2014). Posttraumatic stress disorder and substance use disorder comorbidity in homeless adults: Prevalence, correlates, and sex differences. Psychology of Addictive Behaviors, 28, 443–452. doi:10.1037/a0033674
67.
UngarM. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81(1), 1–17. doi:10.1111/j.1939-0025.2010.01067.x
68.
VanLeitB.StarrettR.CroweT. K. (2006). Occupational concerns of women who are homeless and have children: An occupational justice critique. Occupational Therapy in Health Care, 20(3/4), 47–62. doi:10.1080/J003v20n03_04
69.
WallersteinN.DuranB. (2010). Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity. American Journal of Public Health, 100(S1), S40–S46. doi:10.2105/AJPH.2009.184036
70.
WeybrightE. H.CaldwellL. L.RamN.SmithE. A.WegnerL. (2015). Boredom prone or nothing to do?Distinguishing between state and trait leisure boredom and its association with substance use in South African adolescents. Leisure Sciences, 37, 311–331. doi:10.1080/01490400.2015.1014530
71.
WeybrightE. H.CaldwellL. L.RamN.SmithE. A.WegnerL. (2016). Trajectories of adolescent substance use development and the influence of healthy leisure: A growth mixture modeling approach. Journal of Adolescence, 49, 158–169. doi:10.1016/j.adolescence.2016.03.012
