Bridging the Transition to Housing: A Social Justice Framework to Guide the Practice of Occupational Therapists and Other Professionals who Support Individuals with Experiences of Homelessness (2nd Ed)

Occupational therapists have been supporting individuals who experience homelessness for several decades in their roles as community mental health therapists, on in-patient units, in traumatic brain injury programs, and in multiple other roles. Only recently, however, has this area of practice been acknowledged as distinct. Homelessness is growing in several high and middle-income countries worldwide. Occupational therapists have increasingly expressed an interest in gaining the knowledge and skills to effectively support individuals who experience homelessness, and in recent years, research in occupational therapy that focuses specifically on persons who experience homelessness has grown. The majority of individuals who have been denied the right to consistent and adequate housing are living with disabilities, and often multiple comorbid conditions that impact on their ability to function and participate in activities that are meaningful and necessary in their daily lives [17]. These include mental illness, traumatic brain injury, infectious disease, and physical disabilities [2]. Often, disability has been identified as a cause of homelessness, and a factor that complicates the transition to housing. With expertise in both disability and supporting individuals to function and participate in activities that are needed, wanted or expected of a person in their daily lives, occupational therapists can provide a unique and necessary perspective in the identification of solutions to addressing homelessness, and in supporting individuals across the trajectory of homelessness to housing. The impacts of homelessness do not end when a person is housed. Traumas experienced during and before homelessness remain, and often come to the fore [21, 24, 25]. Several research studies have identified that persons who experience homelessness struggle to sustain their tenancies even with support, and that when they move into housing, other challenges emerge including profound boredom, loneliness, increased substance use, and ongoing mental health difficulties [21, 24, 25, 26, 53]. Often, these factors impact on a person’s ability to function and participate effectively in activities in their daily lives. Given these realities, it is critical to recognize the importance of providing support not only during homelessness, but across the trajectory of unhoused to housing. Occupational therapy in the area of homelessness is now an established practice area with several occupational therapists working in roles dedicated to supporting individuals who are unhoused and housed following homelessness in Canada, the United States, Australia, New Zealand, the UK, Ireland and beyond. This area continues to grow, there is a need to develop resources to guide occupational therapists. An important way to support practice is through the development of a framework to guide occupational therapists as they support unhoused and recently housed individuals. In this document, we present a framework that we have developed to support occupational therapists in this practice area. We have developed this framework as a group of occupational therapy researchers and practitioners with the input of individuals with lived experience of homelessness, and international occupational therapists and researchers. We have developed a framework, rather than an intervention, as we wanted to honour the professional reasoning of occupational therapists as they proceed through each case in their research and practice. By developing a framework, we acknowledge that occupational therapists may design individually tailored intervention approaches with each individual person with whom they work. In so doing, we view this framework as a guide, rather than a prescription for practice. This framework remains the first occupational therapy framework aimed at supporting practice and research with individuals across the trajectory of homelessness to housing. We are proud to present this framework to occupational therapy researchers and practitioners, and other health and social care professionals who are interested in supporting individuals during and following homelessness. Our hope is that it will be used to help individuals who have been affected by homelessness to not only remain housed once they have left shelters or the street, but to thrive by developing a life that is health promoting and meaningful - whatever that looks like for them.

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