Empowering Homeless Youth is an important part of combating the homelessness epidemic
One of the first occupational therapy programs was the Hull House, a neighborhood center for women in Urban Chicago (Quiroga, 1995). Although our professional roots lie in the community, occupational therapy in the United States has since slowly drifted away from community roots, shifting towards a medical model of health care (Fisher & Hotchkiss, 2008). Unfortunately, this has led to a gap in services for underserved and marginalized populations that are not eligible for care under this current model and would be best served by occupational therapy services provided at the community-level.
One underserved population is individuals experiencing homelessness. In the current medical model, people experiencing homelessness rarely receive occupational therapy services unless admitted to a hospital or rehabilitation center. Fortunately, we are seeing an increase in program development for this population through occupational therapy doctoral capstone projects, research efforts, and new funding opportunities. However, gaps in the literature and clinical practice still exist when it comes to people experiencing homelessness, especially youth.
Homelessness is a rising epidemic across the nation. The U.S. Department of Housing and Urban Development reported over 50,000 youth experienced homelessness on any given night in 2018 in the United States, and more than two-thirds of these youth were unaccompanied. Nevada has one of the highest rates of unsheltered unaccompanied homeless youth in the country with more than 20,000 school students experience homelessness each year (The U.S. Department of Housing and Urban Development, 2018). Because of this devastating problem, we sought to develop a community-based occupational therapy intervention for homeless youth in Southern Nevada. We partnered with a local non-profit organization providing drop-in services for homeless youth. The organization provides youth a place where they can socialize, eat a meal, obtain donated items, take a shower, do laundry, and meet with a social worker at no cost. During our needs assessment, we met with the onsite social workers to inquire about current services provided and areas for future programming. This was the first time, in the organization’s 18 years of serving homeless youth, that occupational therapy services would be provided. After educating the staff on the role of occupational therapy, the social workers recommended that we gear our intervention towards life skills. They attempted multiple volunteer-led life skills classes in the past with topics such as resume writing, basic health care knowledge, and interview skills, but felt the classes were not well received. The youth were not engaged in the process and had a difficult time seeing the benefit and application of those topics for their future.
During our needs-assessment at the drop-in center, we observed most of the youth generally disengaged. The youth were occupied with center computers, television, video games, and social media. Through our interaction with the youth, we found that they had received plenty of life skills education but lacked self-efficacy. Many of their comments contained undertones of unhealthy occupational identities and learned helplessness (e.g., “I don’t really have any hobbies because I am not good at anything,” “That sounds fun but I have never done that and probably couldn’t do it anyway.”). We realized our plan to develop basic life skills training classes was leading us down the wrong path. Our conversation shifted from what life skills training to provide, to what types of occupations could empower these youth. Using the Model of Occupational Empowerment by Fisher & Hotchkiss (2008), we began to focus on designing group interventions that would promote positive occupational change, develop positive occupational identities, and improve self-efficacy. Our overarching goal was to promote positive occupational change through improved self-efficacy with increased engagement in healthy behaviors.
Fisher and Hotchkiss (2008) created a model of occupational empowerment based on their work in homeless shelters. They described the presence of disempowering environments, which lead to occupational deprivation and reinforced learned helplessness. During our time at the drop-in center, we observed unhealthy occupational identities (e.g., poor self-efficacy, depressed moods, lack of initiation, lack of leisure occupations, lack of aspirations), possibly due to occupational deprivation (e.g., limited financial resources, limited after-school opportunities, limited role-models, lack of support system, etc.). Fisher and Hotchkiss (2008) recommended remediation through empowerment groups, power projects, social support, and student involvement. Empowerment through occupation leads to the development of positive occupational identity and competence, which promotes positive occupational change. Fisher and Hotchkiss (2008) found that as self-efficacy and healthy behaviors evolve with empowering occupations, homeless individuals can begin to meet educational goals, maintain employment, establish a home, achieve family unity, and improve their overall quality of life.
Our intervention consisted of a group cooking activity. The youth prepared a shared meal consisting of stir fry chicken, vegetables, and rice, including a variety of healthy snacks and desserts. Each course of the meal had a station run by an occupational therapy student being supervised by an occupational therapist and youth rotated through each station. The youth received education on the importance of healthy eating and how to plan a healthy meal during the activity. A common thread throughout the activity was youth commenting on how making a healthy meal was a lot easier and more fun than they had imagined. Overall, the youth expressed enthusiasm for the food they had made. Many youths expressed a desire to make meals more often at the drop-in center. The youth were engaged, joking, laughing, and sharing tips and tricks throughout the activity. We heard comments such as, “I didn’t know cooking could be this fun,”
“I guess I am pretty cook at cooking, who knew,” and “I want to try and make something from scratch next time, like a whole pie.” Drop-in center staff reported this was the most active and engaged they had seen the youth in a long time.
In implementing this community-based group intervention, the main theme that emerged was the importance of engagement. Although the community center offers classes for the youth, few offer opportunities that lead to true engagement and empowerment. We, as occupational therapy practitioners, know that promotion of and opportunity for positive occupational engagement encourages empowerment. In turn, empowerment leads to the development of positive occupational identities and competence, therefore promoting self-efficacy and encouraging healthy behaviors (Fisher and Hotchkiss, 2008). Occupational therapists can promote positive occupational identities by recognizing when clients are experiencing disempowering environments and occupational deprivation. Occupational therapists can design interventions that support remediation through engagement in empowering occupations. This model also applies to other populations, such as home-bound older adults, individuals of lower socioeconomic status, clients residing in inpatient facilities, and students with disabilities, to name a few. We must identify clients experiencing occupational engagement deprivation and advocate for the power occupational therapy holds in preventing learned helplessness and promoting positive changes in self-efficacy and behavior.
Occupational Therapy Student Impact
Shaylee: The largest take away from this experience was seeing firsthand that these youth have a sincere desire for success and have great potential. The barrier to reaching this success is limited opportunities to practice various life skills. As future practitioners, we now better understand our role as occupational therapists with this population. Understanding that by providing youth the chance to participate in several life skills will have a great impact on their success as they transition into adulthood.
Jessica: Initially, the youth were concerned about making mistakes and doubted themselves and their current skill set. Learned helplessness is fueled with feelings of powerlessness and failure. We witnessed firsthand, how through the occupation of meal preparation, these youth were able to become engaged in a task and achieve fulfillment. It is important as occupational therapists to find specific occupations that empower the youth to break the negative traits and build the attributes that lead to self-determination. We must recognize the important role of a supportive environment in combatting learned helplessness. Additionally, we saw how success in activity could empower this population to strive for greater success during this pivotal time in their lives.
Rachel: As we began to converse with the youth present and encouraged them to join us in the kitchen, they exhibited excitement and enthusiasm for the activity and were eager to share more about themselves. We strove to engage the participants in a hands-on educational activity. The participants reported that they were eager for us to return for more classes, and many were eager to expand their kitchen skills in the future. Providing an opportunity to actively engage successfully promoted meaningful engagement, as well as provided the participants with valuable skills that they can utilize as they transition into adulthood.
Anne was a 15-year old high school sophomore that attended our group session. She demonstrated an immediate interest in participating and shared that she had a deep passion for baking. She had familial connections and memories of baking and was interested in improving her skills in the kitchen. She was familiar with cooking basics (e.g., safety, use of an oven, proper cooking utensils, etc.). However, she rarely cooks and wishes she could “be in the kitchen more, creating new things.”
Anne was very eager to get hands-on experience during our session. She participated in each station and assisted in all courses of the meal. She offered to share what knowledge she had about cooking with her peers when they were hesitant or unsure of what to do next. At one point in the intervention, Anne expressed some nervousness about cutting a watermelon, which she had never done before. After we provided her instructions and a demonstration, she was able to complete the task successfully. She stated, “Once you know how it’s done, it really isn’t that hard.” Anne expressed disappointment in her school’s lack of cooking opportunities for students. Though she has a great interest in the activity, she expressed that she does not have the resources to engage in these activities. We asked her what other meals she would be interested in cooking. Her face lit up as she responded, “Anything and everything. I want to learn new cooking techniques and try new recipes.”
We asked Anne if she had ever considered culinary school. She chuckled slightly and responded, “I don’t see how that’s possible.” Anne continued to chop vegetables and then paused asking, “Do they even have those kinds of schools around here?” After sharing with her the local culinary schools, her next question was, “What would I need to do to get in?” At this moment, Anne was empowered. Before this activity, Anne had not even considered continuing her education after high school graduation. Her environment was disempowering, and as a result of her occupational deprivation, she had an unhealthy perception of herself and her abilities. By participating in an activity that she valued but did not have the opportunity to participate in often, she started to see possibilities for her future. By the end of the session, Anne was asking more about the requirements for culinary school and planned to discuss this new idea with the social worker. We observed a significant change in how she spoke about herself and her future in a short amount of time by providing an empowerment group intervention. This interaction exemplifies how we can promote positive occupational identities and competence through occupational engagement.
Fisher, G. S., & Hotchkiss, A. (2008). A model of occupational empowerment for marginalized populations in community environments. Occupational Therapy in Health Care, 22(1) 55–71. doi: 10.1300/j003v22n01_05
The U.S. Department of Housing and Urban Development. (2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress Part 1: Point-in-time estimates of homelessness (Report No. 5). Retrieved from https://files.hudexchange.info/resources/documents/2018 AHAR-Part-1.pdf