Being homeless or being housed: tales of an occupational transition

Key words : Occupational transitions; occupational engagement; homelessnes Introduction: The occupational needs of homeless individuals living with mental illness are receiving growing attention. However, the literature tends to focus on services delivery. As growing efforts are made to implement supported housing initiatives, the passage from streets to homes becomes not only a concern amongst practitioners, but also the focus of their interventions. Yet, little is known about the occupational nature of this transition. Objectives: This study aims to understand the nature of the occupational transitions and occupational engagement of people living with mental illness who are homeless or recently housed. Methods: A large randomized controlled trial, aimed at measuring the effects of a supported housing approach, was conducted in five Canadian cities. In order to contextualize the impact of housing, narratives were collected from a subsample of participants, while respecting assignments to the comparison groups. This presentation focuses on narratives of participants collected at one site (n=44), at their entry into the project and 18 months later. Each pair of narratives constituted a case. Cases were analyzed individually in order to situate transitions within the participant’s life course occupational development (Davis & Polatajko, 2010) before any comparison. The inductive analysis process focused on the characteristics of this occupational transition by examining its various dimensions such as the nature, experience, value and meaning of occupational engagement, its transformative potential and its relationships with place, time and social environment. Several procedures, including methodological journals and audits, were implemented to ensure the transparency, accountability and procedural rigor of the study. Results: Narratives reveal how occupational engagement is modulated by the experience of homelessness, addiction, trauma and occupational injustices, even beyond homelessness. Initially focused on survival needs, participants strive to meet their need for affiliation and their desire to reclaim their dignity and sense of citizenship, while transforming their occupational patterns and identity. Conclusion: This study offers some empirical basis to substantiate the theoretical foundations surrounding occupational development of an adult population. In addition, it highlights overlooked occupational issues experienced by persons who are homeless or recently housed. Occupational changes associated with being housed occur slowly as participants redefine their social and occupational identity, shift their frame of reference and strive to come to terms with their potential occupational engagement while remaining faithful to their history