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

Abstract

Background: Current health care policy supports occupational therapy services with individuals experiencing homelessness in primary care settings. Research on the impact of interventions is needed to support this emerging practice area. Method: : A retrospective, descriptive study was completed following the initiation of full-time occupational therapy services in an integrated primary setting and Federally Qualified Health Center (FQHC) for clients experiencing homelessness. This study evaluated: (a) percentage of referred clients who engaged in ongoing intervention; (b) diagnostic demographics of those referred; (c) functional goal types and frequency; (d) a comparison of preintervention Canadian Occupational Performance Measure (COPM) scores with postintervention scores. Results: : Analysis of data revealed clients referred for occupational therapy services present with complex co-morbidities. t tests for matched pairs (p < .05) revealed that participants had a statistically significant improvement in COPM performance scores (69%) and in COPM satisfaction scores (73%) between baseline and postintervention. Diagnostic subgroups had a similar rate of improvement. Analysis of client identified COPM goals revealed a high rate of instrumental activity of daily living focused goals. Conclusion: : Integration of full-time occupational therapy services into FQHC settings increases client access to functional-based rehabilitation services that address physical and behavioral health. Individuals experiencing homelessness demonstrate improvement toward functional goals using client-centered goal setting processes and interventions. Comments The authors report no potential conflicts of interest.

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).…”

“…Males or men comprised the majority of the study sample in 11 articles, ranging from 52 to 90% (45,48,52,(54)(55)(56)(57)(58)(59)(60)(61)(62), and one article included only women in their sample (47). Except for case studies (N = 2) (46, 53), none of the studies stratified the findings by sex or gender.…”

“…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).…”

“…The program involved a mobile unit consisting of addiction medicine clinicians, public health advocates, and harm reduction specialists who delivered primary care, addiction treatment, and harm reduction services to four locations on the same day at the same time each week. The remaining studies in this category described an occupational therapy intervention at an integrated healthcare site or Federally Qualified Health Centers (FQHC) that provided comprehensive services for individuals experiencing homelessness (50,52). Occupational therapy services included an evaluation, individualized intervention focusing on clientidentified goals and occupational performance, and consultation (e.g., discussion and treatment planning with another provider and evaluation of environments).…”

“…Interventions in this category did not detail strategies for tailoring interventions for TBI-related impairments. It is worth noting, however, that the studies on the occupational therapy intervention referred to TBI as a complex medical condition and specifically reported that TBI, a history of head trauma, or medical conditions that affected cognition constituted most referrals for an occupational therapy evaluation (50,52). Providers in the FQHC also noted the value of occupational therapy in providing an in-depth understanding of cognitive challenges and their impact on an individual's daily life activities and subsequently determining necessary supports (50).…”