Date Presented 04/23/2023

Interventions that support persons to leave homelessness are known to be effective for improving housing stability but are less effective for supporting thriving after homelessness. This presentation will describe a community-based participatory research project that was conducted to codesign a novel intervention called the 'Peer to Community Model,' aimed at supporting individuals to integrate in their communities after homelessness through meaningful activity and peer support.

Primary Author and Speaker: Carrie Anne Marshall

Contributing Authors: Brooke Phillips, Abe Oudshoorn, Alexandra Carlsson, Ashley O'Brien, Chelsea A. Shanoff, Corinna Easton, Ellie Lambert, George Panter, Julia Holmes, Marlo Jastak, Sarah Collins, Rebecca Ridge, Terry Landry, Rebecca A. Goldszmidt, Matthew Hall, Sophie Kiwala

PURPOSE: Homelessness is growing in high-income countries internationally, and solutions are needed. To prevent ongoing homelessness, there is a need to identify ways of helping individuals to ‘thrive’ rather than just sustain their tenancies following homelessness. Research within and outside of occupational therapy highlights the importance of meaningful activity for supporting psychosocial well-being and community integration in the lives of persons with experiences of homelessness (Marshall, Gewurtz et al., 2022; Marshall, Davidson et al., 2019). Occupational therapists’ expertise in meaningful activity engagement may make an important contribution in supporting thriving and preventing ongoing homelessness. Co-designing novel approaches alongside persons with lived experience, researchers and practitioners is needed.

DESIGN: We conducted a community-based participatory research study in two cities in Ontario, Canada. This study was guided by a community advisory board (CAB) comprised of persons with lived experience of homelessness, service providers, researchers and policymakers. We conducted this study in two phases: 1) we conducted a stakeholder consultation with 46 persons with lived experience of homelessness and mental illness, 38 service providers, and 22 organizational leaders (n=106); and 2) used the findings of our stakeholder consultation to co-design a novel intervention aimed at supporting individuals to attain the necessary conditions for thriving following homelessness.

METHOD: Qualitative interviews with stakeholders were semi-structured, transcribed verbatim and analyzed abductively informed by lenses of social justice and health equity. Two technical reports were developed that summarized findings for each site, and distributed electronically and through virtually delivered presentations with the broad community. Members of the broad community were then invited to participate in co-design sessions to develop a novel intervention to fill gaps and build on the strengths of current services across these two communities.

RESULTS: The findings of our stakeholder consultations across both study sites were remarkably similar, and emphasized the importance of targeting community integration and belonging following homelessness. Themes highlighted the importance of peer support and meaningful activity as pathways to integrating in one’s community following homelessness. In response to this, our CAB designed a novel model called the ‘Peer to Community Model' which is designed to target community integration following homelessness. This model includes: 1) a central space in the community including a social enterprise designed to bring together persons from the broad community with persons who experience homelessness; 2) program staff including low ratio peer support, occupational therapy and social work; and 3) a weekly support meeting aimed at mitigating moral distress among program staff.

CONCLUSION: Developing a novel intervention targeting community integration, informed by the perspectives of persons with lived experiences of homelessness, health and social care providers (including occupational therapists), researchers and policymakers has provided an opportunity address an outcome that has been challenging to address in research on homelessness (Marshall, Boland et al., 2020) using an occupational lens. Currently, we are conducting a pilot study to assess feasibility and acceptability of this approach to inform future refinements and to collect initial effectiveness data. Outcomes of this research will be used to influence existing programs aimed at supporting individuals to sustain their tenancies, prevent ongoing housing loss, and thrive in their communities after the trauma of homelessness.


Marshall, C. A., Davidson, L., Li, A., Gewurtz, R., Roy, L., Barbic, S., Kirsh, B., & Lysaght, R. (2019, Apr 15). Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study. Can J Occup Ther, 8417419833402.

Marshall, C. A., Boland, L., Westover, L. A., Marcellus, B., Weil, S., & Wickett, S. (2020, Nov). Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review. Health Soc Care Community, 28(6), 1843-1862.

Marshall, C., Gewurtz, R., Ross, C., Becker, A., Barbic, S., Roy, L., Lysaght, R., & Kirsh, B. (2022). Beyond securing a tenancy: Using the capabilities approach to identify the daily living needs of individuals during and following homelessness. Journal of Social Distress and Homelessness, Accepted for publication.

Goering, P., Veldhuizen, S., Watson, A., Adair, A., Kopp, B., Latimer, E., & Aubry, T. (2014). National At Home/Chez Soi Final Report.