Homelessness: Challenges for OT

Despite the current support and the identified potential for furthering OTs role with the homeless population seeker population, there are challenges present that impact the feasibility of providing services.  

Job Availability

OTs are not regularly hired into positions as direct service providers or consultants at shelters/primary care settings that serve the homeless population despite a long history of supporting individuals with mental illness and other various challenges to successfully live in the community (Merryman & Synovec, 2017). Readily available employment opportunities are also difficult to come by. Often, OTs must be prepared to volunteer their time to gain access to facilities that serve the homeless and develop trust over time.


Furthermore, OTs are also not formally recognized as qualified mental health professionals in several states (AOTA, 2017letter?) However, recognition as a qualified mental health professional (QMHP) is not required to operate as a mental health OT. This absence of acknowledgment elevates the need to advocate on behalf of OTs being competent in this area of practice. Mental health OTs also make up one of the smallest areas of specialty across the profession (AOTA, n.d.f.).  


Obtaining reimbursement for providing OT services in community-based and community-built settings is also very difficult (Bradley et al., 2011). Social service agencies that traditionally offer services to the homeless population historically have very limited funds to attribute towards resources, which leads to difficulty paying an OT a fair rate. Accepting employment with low reimbursement is challenging for many OTs, especially those with high student loan debt.

Entitlement Programs

OTs also face a challenge in that they do not generally receive extensive training regarding entitlement programs and social service agencies that clients living in the community deal with daily (Dallas, 2019). This can pose a significant challenge when working within community-based settings. Ultimately, it becomes the OT's responsibility to self-educate and to decipher the very complex programs and agencies in order to best serve their clients.

Grant Writing

Because of the challenges with reimbursement, OTs must often be prepared to independently identify and compose grants to secure funding for their reimbursement and any necessary program materials (Doll, 2010). Grant writing takes skill and practice (Reynolds & Lane, 2010). Unfortunately, grant writing is not a skill routinely taught in the occupational therapy curriculum.    


Unfortunately, there is also limited research available for the effectiveness of specific OT interventions with the homeless population (Thomas et al., 2011). There is considerable heterogeneity in the research methods that are utilized to examine the effectiveness, which makes it impossible to make direct comparisons of findings. Inconsistent assessment measures also contribute to difficulties with making direct comparisons (Thomas et al., 2011). With OT being an evidence-based profession, this poses challenges for development within this emerging area.