The Barriers and Challenges of Homelessness and How OTs Can Help

At the beginning of occupational therapy school, I was asked to create a few goals for myself to enhance my professional and personal development. One of the goals that I made was to grow as a client and occupation-centered practitioner by expanding my knowledge of minority and underserved populations, specifically the homeless population.

When I first created this goal with the help from my faculty mentor, I did not know yet exactly which underserved or minority population I wished to focus on. I ultimately decided to focus on homelessness when this population kept coming into conversation with friends and family, and I found myself sticking up for the homeless while others tended to have extremely negative and degrading things to say. While I stuck up for the homeless, I found myself always struggling to response to questions such as "why don't they just get a job?" and statements like "they're just lazy", and "don't give them your money, they'll just spend it on drugs." In my heart I knew that these negative questions and statements were completely wrong, but I still struggled to respond when in reality, I had no idea all of the events that play into causing someone to be and stay homeless. Because of this, I decided to educate myself.

I started the process of educating myself by looking up TedTalks on homelessness. One of the first videos that I came across was "Homeless by Design" by Maurice Young. In this TedTalk, Maurice speaks of what life is like in a homeless shelter. He is experienced in extremely knowledgeable in this area as a result of living in countless homeless shelters himself. His reason for being homeless is a little different from the norm, though, because he is homeless by choice (aka by design). 

Maurice speaks of how he used to be your typical young adult with big aspirations for the future: graduate highschool, go to college, get a good job that pays high, get married, have children, etc. While he succeeded in accomplishing many of these things, he speaks of his misfortune of going through three divorces. After his last divorce, he decided that he needed to find somewhere to go and clear his head and reflect. This place ended up being a homeless shelter. After being in the homeless shelter for three days, he speaks of noticing a distraught man carrying around a pile of papers that he recognized to be job applications. After approaching the man to discover what was wrong, Maurice learned that the man did not knw how to read and thus could not fill out the applications. Maurice helped the man fill out and deliver the applications, and then set up daily tutoring sessions with the man to teach him how to read.

Maurice goes on to speak about many other people that he had the opportunity to assist in the homeless shelter. After a couple of weeks of doing this unintentionally, one morning he noticed a line of people forming next to the place that he usually used to sit and reflect. This line of people was forming for one reason: to receive assistance from Maurice. In this moment, Maurice discovered that his purpose in life was to help these people. He ultimately made the decision to become homeless permanenelty to better understand the struggles of the people that he was helping. 

From this TedTalk, I learned how many people who find themselves homeless want help and want to get out of their current situation, but they just do not have the resources and the assistance to do so. After realizing this, I found myself reflecting upon the nature of homeless shelters. Aren't they supposed to help these people? Shouldn't they be providing these people with the resources that they need to get started again? After researching these questions, I learned that more often than not, homeless shelters tend to make it more difficult to get out of homelessness. 

I happened upon one more TedTalk titled "How trauma informed design could transform homeless shelters" by Brandi Tuck. I was drawn to this video because it reminded me of Trauma-Informed Care, a topic that we have learned about numerous times while in occupational therapy school. In this TedTalk, Brandi speaks of the chaotic, disorderly, and stressful environments of many homeless shelters. She also speaks of how many homeless shelters do not offer privacy to its inhabitants, and many have rigid expectations that result in people feeling powerless and controlled.

Brandi also speaks of how the human brain responds to stress. There are positive and negative stress responses. Our brain's negative response to stress (Distress) puts our brains in survival mode, a constant state of fight or flight. This chemical reaction "turns off" our prefrontal cortex, which is responsible for unique human responses such as rationality, critical thinking, and logic, because our brains are in survival mode and only concerned with keeping us from danger. If someone's brain stays in this state for too long, the brain can actually rewire itself to be hypervigilant and constantly in that maladaptive stress response. This results in chronic slowed processing and decision-making, insomia, difficulty with emotional regulation, emotional detachment, and depression. 

Brandi explains in her TedTalkhow homeless shelters actually contribute to and exacerbate the stress response in homeless people due to the chaotic structure and rigid expectations. Due to this, Brandi speaks of a better way to shelter centered around trauma-informed design. This design incorporates privacy, a calming and relaxing color palette, space for social participation, and much more. By meeting the basic needs that people would like in their homes with the proper design elements, inhabitants can start to ease their stress and start to make better informed decisions in other aspects of their lives.

Finally, I moved on to research the role that occupational therapists can play in the lives of homeless people. I found the AOTA Continuing Education Article's "Community-Built Occupational Therapy Services for Those Who Are Homeless." This article goes into depth on the various causes that force people into homelessness, the barriers and struggles that homeless people face, and the various roles that OTs can play in homelessness. 

According to this article, common causes of homelessness include domestic violence, mental illness, decreases in public assistance programs, and loss of employment. Barriers that homeless people face include lack of transportation to make it to appointments and job interviews on time; poor literacy skills, resulting in inability to complete paperwork; lack of material resources; and concern about stigma from staff at support organizations. Barriers also exist in the homeless shelters themselves, such as strict curfews, mealtime schedules, and mandatory check-ins that result in few opportunities to make idnependent decisions and choices regarding occupational performance. Overall, these barriers and challenges result in stress, limited opportunities to engage in meaningful occupations and decreased independence in occupational performance, which ultimately result in negative health outcomes and decreased well-being. 

This article discusses how OTs can play a role in increasing occupational engagement, independence, and overall well-being in people who are homeless. The article breaks down interventions for specific groups of people, including individuals, families, single mothers, parents, domestic violence survivors, youth, and children. Intervention ideas include working in the actual homeless shelters and reviewing shelter policies, such as intake processes, curfews, and access to resources, to integrate occupational engagement and safety; addressing occupational engagement through group and individual skill-building exercises for gaining employment; experiences that explore community resources; implementing art and drama classes to improve socialization; addressing basic self-care skills; assisting parents with children transition to work; money management; etc. The ideas are endless!

From all of these resources and my research on homelessness, I can now say that I have a better understanding of the different challenges and barriers that this underserved population experiences. I now know how I can respond when people make statements like "they should just go an get a job." I can say how most homeless people WANT to gain employment, but they have not been supplied with the proper resources, knowledge, transportation, direction, confidence, etc. in order to even start the process of getting a job, let alone the homeless shelter they might be residing in is stressing them out to the point that their brains literally cannot make a ratonale and clear decision due to being in survival mode. 

Fortunately, though, as an OT there are numerous ways to assist in these areas, and I cannot wait to become a practitioner and actually start the process.