Transforming Healthcare
for Homeless People:
The Value of
Occupational Therapy
Sophie Koehne
Dan Lescure
John Sapani
KHP Pathway Homeless Team
Session outline
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Homelessness: the Context
The Pathway approach
Homelessness: health and Social issues
Why OTs?
Experience of establishing roles
Service Evaluation
Case studies
What is homelessness?
Homelessness is about more than rooflessness. A home is not just a physical space, it
also has a legal and social dimension. A home provides roots, identity, a sense of
belonging and a place of emotional wellbeing. Homelessness is about the loss of all of
these. It is an isolating and destructive experience and homeless people are some of
the most vulnerable and socially excluded in our society.
(Crisis)
Includes: Rough sleeping, in Temporary
Accommodation, Sofa surfing, Squatting,
Facing eviction
Long term homeless
Recent or sudden homelessness
Homelessness: the context
• Homelessness Reduction Bill 2017
• Homelessness: a silent killer (Crisis, Dec 2011)
• Healthcare for Single Homeless People (Department of
Health 2010)
• “high quality, integrated services that meet their health
needs” (St Mungos, 2016)
• Turned away (Crisis, Oct 2014)
Compared to the general population,
Homeless people:
• Attend A&E 5 times as often
• Are admitted 3 times as often
• Cost 8 times as much
Homelessness in London
Rough Sleepers in London (CHAIN data)
9000
Increase of 20%
between and 2013-2014
and 2015-2016.
7581
8000
7000
8096
6508
6000
5000
4000
3000
2000
1000
0
2013/2014
2014/2015
2015/2016
Reason for Homelessness
40%
38%
35%
35%
30%
25%
21%
20%
15%
15%
13%
10%
6%
5%
1%
0%
2%
6%
7%
7%
8%
8%
9%
21%
35%
Pathway Approach
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Homeless people repeatedly discharged & readmitted without proper planning or
coordination
Impact of homelessness & links to health and addiction may not be recognised by clinical
teams
Need for integrated pathway for homeless patients
Pathway team helps support clinical teams
Support collaborative care across health, housing, social and voluntary sector, increasing
safe discharge
Non-traditional patient in a traditional setting
Health Issues
Tri-morbidity
Early Aging
Late diagnosis
and treatment
Capacity
issues
Risk of Falls
Substance
misuse
Brain injury
BBV
Amputees
Respiratory
illness
Liver disease
Cardiac
problems
Cognitive
Impairment
Epilepsy/Fits
Psychosis
Suicidality
Personality
Disorder
Learning
disability
Unspecified
Mental health
difficulties
Depression
Cancer
Dental issues
Social Issues
Stigma
Difficulty
accessing
healthcare
Lack of
privacy
Poor Life
Skills
Social
exclusion
Homeless
patients
Poor
communic
ation
Recurring
patterns of
behaviour
No ID or
documents
NRPF
Financial
problems
Transient
population
Having just a house doesn’t solve
homelessness
Why OTs?
Experience of client group
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Loss of roles
Unstable living Environment
Loss/change of Identity
Loss of skills
Disempowerment
Stigma
Lack of structured occupation
Lack of opportunity
Lack of control
Lack of Privacy
Lack of resources
(Chard et al, 2009; Illman et at 2013)
OT Skills
• Understanding impact of
environment
• Versatility/adaptable
• Transferable skills
• Training across physical and
mental health
• Outcomes orientated
• Advocacy
• Rapport building – client centred
practice
• Creative use of occupation –
enabling
(Grandisson et al, 2009)
Experience of establishing our roles
OT role in MDT
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Allocation of case load
OT ax (appro, added value)
Using specific OT skills – (Joint working)
Establishing working interface with
wards/ward based OT’s
Experience of establishing our roles
Maintaining OT identity in generic role
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Setting up service – OT focus in team initial assessment
Writing housing support letters with OT focus
Providing training to OTs within Trust
Peer Support
Establishing an OT Network – national interest
Experience of establishing our roles
Transitional work
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Discharge doesn’t mean resolved
Linking in
New challenges
10 day post-discharge
Service Evaluation
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Reduced Length of Stay
Reduced readmission rates (not across all sites)
Developing OT Intervention Outcomes
Future Opportunities
- Inreach into hostels
- Experts by Experience
- Expanding OT Network
Case study
Background:
Rough sleeper – Evicted from flat
No GP
No benefits
Health:
Multiple Physical health
Cognitive impairment (Suffered an RTA)
Discharge outcome:
Nursing home
Challenges:
Advocacy
Safe discharge
Interface of working with ward OT’s
OT assessments and interventions:
• MoCA (Montreal Cognitive Assessment)
• Capacity Assessment
• Assessment of functioning
Patient goals:
• Having somewhere safe to live and support
• Engaging in music
• Employment (customer service)
Rosie’s story
Multi-agency and Multidisciplinary
References
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Crisis. Available at: www.crisis.org.uk (Accessed 16/06/17)
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Homeless Link. Available at: www.homelesslink.org.uk (Accessed 16/06/17)
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Turned Away, Crisis. Available at:
https://www.crisis.org.uk/media/237024/mysteryshopping_report_final_web.pdf (Accessed 16/06/17)
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Grandisson, M., Mitchell-Carvalho, M., Tang, V. and Korner-Bitensky, N. (2009) Occupational therapists'
perceptions of their role with people who are homeless, British Journal of Occupational Therapy, 72 (11),
pp. 491-498.
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Stop the Scandal, St Mungo’s. Available at: http://www.mungos.org/documents/7021/7021.pdf (Accessed
12/01/17)
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Pathway. Available at: http://www.pathway.org.uk/ (Accessed 12/01/17)
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DH (2010) Healthcare for homeless people, London: Department of Health
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Illman, S., Spence, S., O’Campo, PJ., and Kirsh, B. (2013) Exploring the occupations of homeless adults living
with mental illness in Toronto, Canadian Journal of Occupational Therapy, 80 (4), pp. 215-223
References
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Chard, G., Faulkner, T., Chugg, A (2009) Exploring occupation and its meaning in homeless men, British
Journal of Occupational Therapy, 72 (3), pp. 116-124.
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Thomas, B. (2011) Homelessness: A silent killer - A research briefing on mortality amongst homeless
people. London: Crisis.
Any Questions?
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