Integrated Care: Provider referrer perceptions of occupational therapy services for homeless adults in an integrated primary care setting

Abstract

BACKGROUND: Occupational therapists have a long history of addressing community performance and participation challenges faced by individuals with complex, chronic conditions, including those with serious mental illnesses (SMI) and cognitive issues that present with a traumatic brain injury (TBI). Healthcare reform has shifted incentives to support practices that promote successful community life for people with complex medical conditions. Community based care models emphasizing integrated primary care, such as Federally Qualified Health Centers (FQHC) are emerging, and a generalist role for occupational therapy is being defined. Those with complex comorbid conditions such as mental illness, substance abuse and traumatic brain injury are at risk for negative health outcomes that are further compounded by homelessness. There is a critical need to understand effective treatment options for this population to reduce the negative effects of chronic health conditions. As occupational therapists further define a role serving traditional clients in less traditional settings, such as the FQHC, it is helpful to explore the perceptions of the utility of OT services on the part of provider referrers. OBJECTIVE: This study explored provider referrer perceptions of a new occupational therapy service for homeless adults in an FQHC to assist effective allocation of scarce resources. METHODS: Twelve provider referrers at an FQHC were interviewed regarding their perception of the role and utility of occupational therapy in this setting. Interviews were then coded for themes. RESULTS: Providers identified the unique value of occupational therapy, emphasizing critical information gleaned from the performance-based assessment of functional cognition, and the positive impact on team interactions and subsequent care decisions. CONCLUSION: Occupational therapy provides a distinct perspective on client performance in FQHC settings indicating benefit for inclusion of services.

Rehabilitation among individuals experiencing homelessness and traumatic brain injury: A scoping review

“…After duplicates were removed, 4,439 titles and abstracts (227 non-English language) were (47,48,53). None of the rehabilitation programs or interventions were based at an inpatient or outpatient rehabilitation setting; 17 of 18 articles described communitybased rehabilitation that were offered through community organization healthcare clinics (45,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62) or mobile clinic (54), while one article described a medical respite program that provided care to individuals onsite (46).…”

“…Fourteen articles defined homelessness as part of their inclusion criteria, description of the study sample, or study setting ["absolutely or precariously housed" (55,56,58,59), "experiencing homelessness" (45), "doubling up-friends and family" (62), "shelter, unsheltered, doubled-up" (54) "residing in homeless shelter or on the street" (47,48,51), "scattered site apartments" (45), "respite program" (46), "transitional housing" (62) or participants were referred to as "homeless individuals" (49,50,52,53,57)]. Six articles reported participants intersected with the justice system [i.e., "ever been to jail" (45), "ever been to prison" (45), "arrested in the past" (58), "arrests in the past 6 months" (56), "times in jail/prison" (49), "had prior justice involvement" (60, 61)], with prevalence ranging from 16 to 80% (45,49,56,58,60,61).…”

Occupational Therapy in Integrated Primary Care: Addressing the Needs of Individuals Experiencing Homelessness

“…Opportunities to access services according to clinical need rather than strict medical necessity in a familiar setting likely enabled client progress. The goals identified by the clients reflect the importance of services focused on IADLs development, and occupational therapy provides a unique focus on functional skills (Merryman & Synovec, 2020). This delivery model reflects the characteristics and fit for occupational therapy in integrated primary care emphasized in the literature since FQHCs are designed to minimize the barriers that often prevent engagement in traditional health care and rehabilitation settings (Bonin et al, 2010;Dahl-Popolizio et al, 2016;Halle et al, 2018;Koverman et al, 2017).…”

“…By co-locating in FQHC sites, occupational therapists have the opportunity to provide individual interventions and to collaborate with other health care providers to provide comprehensive care to a complex population (Halle et al, 2018;Merryman & Synovec, 2018). Merryman and Synovec (2020) explored the perceptions of providers in an integrated care environment using a FQHC model that served homeless adults regarding the integration of occupational therapy services.…”

“…Providers emphasized the importance of the function-based perspective of occupational therapy both in assessment and intervention and considered this as an important extension of comprehensive and team-based care, particularly in the area of functional cognition, stating that this information influenced care decisions and discharge plans (Merryman & Synovec, 2017;Merryman & Synovec, 2020).…”