Occupational Therapy in Practice: The Skid Row Housing Trust in LA

As part of a collaborative team, OTs are uniquely skilled to help address the many and various needs of the unhoused.

Phillip D.H. Lee, OTD, OTR/L, Occupational Therapy Program Manager at Skid Row Housing Trust.

The 2020 Greater Los Angeles Homelessness Count found that there are 66,436 people experiencing homelessness in LA County. That’s a 12.7 percent increase over the previous year and a 70 percent increase from 2010. Two-thirds of the county’s homeless population, as measured in the 2020 count, are experiencing homelessness for the first time, largely due to economic hardship. But the data for 2020 was collected before the impacts of the Covid-19 pandemic could be felt and measured—and the true figures are likely to be even higher.

Reducing the rate of homelessness, on a macro level, requires policy reform. But caring for the homeless population that already exists in LA County requires personalized attention. Research has shown that individuals experiencing homelessness are provided with limited opportunities to engage in meaningful occupations, which in turn leads to poorer health outcomes, social interactions, and well-being.

Often, underserved populations also are not covered by traditional medical or educational services, yet they still have occupational needs. As a result, some homeless services, housing organizations, and health providers are now bringing in occupational therapists (OTs) as part of their care coordination teams for the homeless population.

The Important Work of the Skid Row Housing Trust

Skid Row Housing Trust provides permanent supportive housing so that people who have experienced homelessness, prolonged extreme poverty, poor health, disabilities, mental illness, and/or addiction can lead safe and stable lives. So far, the Trust has managed a 90 percent retention rate for residents in their first critical year after exiting homelessness. Part of that can be attributed to the fact that, in addition to housing, the Trust provides the community with welcoming and dignified spaces for primary care, mental health, and linkages to supportive services. Occupational therapists like Lee play a critical role.

“As OTs, we are trained in both understanding disabilities and supporting individuals, so that they can participate in all the activities that are needed, wanted, or expected of them,” Lee says. “While it is important to help these individuals improve their functional capabilities, ultimately, we want to empower these individuals to work on goals that are important to them.”

How Do Occupational Therapists Help People?

In permanent supportive housing environments, like those offered by the Trust, OTs may be brought in to assist new residents in adapting to their new homes. They can also work with residents to increase functional independence in their Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADLs). In some ways, this is occupational therapy in a traditional sense: providing strategies to help manage chronic physical health conditions, or brainstorming leisure activities that can help one engage within their community.

All occupational therapists need good communication and interpersonal skills, along with patience and the ability to problem-solve. But working with those who are experiencing homelessnesss requires its own set of contextualized considerations.

The prevalence of chronic health conditions such as hypertension, diabetes, and respiratory diseases is high, and many in the homeless population also struggle with complex mental health illnesses and co-occurring substance use disorders. Institutional and/or societal discrimination complicate the issue further. In working with this population, Lee points to Dr. Carrie Anne Marshall’s Bridging the Transition From Homeless to Housed as a key resource, with its emphasis on five principles: social justice, housing first, recovery, harm reduction, and intersectionality.

“One of the most important things to remember when working with people who are experiencing homelessness and/or have experienced homelessness is their trauma,” Lee says. “These negative past experiences, along with accelerated physical health conditions and/or mental health challenges, do not quickly dissipate even after a person is housed. Trauma, like pain, is a very subjective experience, and as healthcare professionals, we need to be mindful of how these traumatic experiences can impact, influence, and shape one’s actions, thoughts, and behaviors.”

At the Trust, residents, case managers, and property managers have responded positively to the empathetic and non-judgmental approach taken by occupational therapists like Lee. And developing positive relationships is critical for working with a population that’s often scarred by the negative experiences they’ve had while living in the streets.

“Developing trust and being authentic, which takes time, eventually allows us to work with clients so that they can be rehabilitated, recover, and heal from their past traumas,” Lee says. “Little by little, we can help our residents make meaningful changes so that they can improve the quality of their lives.”

Both OT practitioners and students have facilitated a variety of group programs at the Trust. They have run cooking and smoothie groups, which have earned high turnouts, and offered more than just the usual free meal. They have co-facilitated manualized interventions such as Seeking Safety, an evidence-based group counseling model to help individuals attain safety from trauma and/or substance use. And they have also run art groups that provide a safe space for residents to come together and create art with their neighbors.

“Last summer, one of our OT students at the St. George Hotel set up a beautiful art gallery in the shared community space, which was really appreciated by many residents,” Lee says. “Every time I visit that building, residents ask if they will be having another OT student join them for the semester.”

Lee and his colleagues at the Trust also provide one-on-one services that are individualized, holistic, and client-centered, meaning they work on the goals that individuals want to work on. By shedding diagnostic labels, they can learn and get to know each person, and understand who they are. These one-to-one sessions can range from helping a person with routine daily activities, such as dressing and grooming, to more complex tasks, such as completing a resume so that they can get back to work.

“In some instances, I’ve been able to accelerate the acquisition of external services, and in other instances, I’ve been able to successfully advocate for modifications in the unit, so that the resident could safely and independently use the restroom,” Lee says. “I’ve also helped residents pass their annual Housing Authority of the City of Los Angeles (HACLA) inspections so that they don’t lose their rental subsidies.”

Occupational therapists can also play other positions within a coordinated team, filling in for overwhelmed case managers and providing extra assistance to residents. The COVID-19 pandemic has added a new level of complexity, with many shelters forced to run at reduced capacity.

“Unfortunately, for many of our unhoused Angelenos, this proved to be quite difficult and many were left without the needed services,” Lee says.

Service providers have had to scramble to distribute food, hygiene kits, and other resources to people experiencing homelessness, to those staying in shelters, and to those already living in permanent supportive housing.

At the Trust, staff members from various departments have collaborated together to procure food donations and hygiene kits from outside organizations and local restaurants, such as the Los Angeles Food Bank and Milpa Grille, to ensure that those that needed food during this emergency time were able to eat.

But while the pandemic has changed some of the ways in which Lee and the Trust interact with those experiencing homelessness, the core mission of occupational therapy remains the same.

“We firmly believe that the intentional use of one’s time and energy towards meaningful activities, and the engagement in occupations, can improve one’s health and overall sense of wellbeing,” Lee says.

Matt Zbrog

Matt Zbrog

Writer

Matt is a writer and researcher from Southern California. He’s been living abroad since 2016. Long spells in Eastern Europe, Southeast Asia, and Latin America have made the global mindset a core tenet of his perspective. From conceptual art in Los Angeles, to NGO work on the front lines of Eastern Ukraine, to counterculture protests in the Southern Caucasus, Matt’s writing subjects are all over the map, and so is he.

Related Articles

Related Articles