Date Presented 04/02/2022
Transgender and nonbinary individuals experiencing homelessness encounter myriad health disparities that affect their quality of life. As OT expands into the LGBTQIA+ community, it is vital to develop programming for this population to cultivate independent living skills. This session will present outcomes of a life skills program used with transgender and nonbinary participants experiencing homelessness and the impact it had on their ability to achieve housing and employment goals.
Primary Author and Speaker: Olivia M. Van Dyke
Contributing Authors: Meghan Blaskowitz
PURPOSE: Members of the LGBTQIA+ population experience discrimination that leads to poor social determinants of health including poverty, unemployment, and housing instability. In 2020, 8% of all transgender adults experienced homelessness (Wilson et al., 2020). Transgender (trans) and nonbinary (NB) adults are twice as likely to experience homelessness compared to cisgender counterparts. This population also lacks opportunities to participate in meaningful occupations (Hild et al., 2019). This project aimed to understand how an 8-week client-centered life skills program impacted trans and NB participants’ ability to achieve their independent living goals. Researchers conducted a descriptive study of a life skills training program for trans and NB residents at a transitional housing facility (THF) to measure outcomes of the program, inform future iterations of program development, and describe OT’s unique role in working with trans and NB individuals.
DESIGN: Researchers used a descriptive design to gather qualitative and quantitative data from four trans and NB participants at the beginning, during, and following the life skills training program. Participants completed group and individual intervention sessions targeting occupations vital for independent living, such as financial management, community mobility, and vocational exploration. Residents (n = 3) and alumni (n = 1) of the transitional housing program were recruited through convenience sampling; all participants identified as trans or NB.
METHOD: Each participant completed a Kawa River Model and motivational interview prior to the program to understand what was meaningful to them. Goal Attainment Scaling (GAS), the Canadian Occupational Performance Measure (COPM), and a satisfaction survey tracked participants’ progress in response to the program and measured outcomes over time. Qualitative data from the Kawa and motivational interview were transcribed verbatim and examined using thematic analysis. Key themes were extracted from transcriptions and defined using open coding. Quantitative data from the GAS and COPM were analyzed using descriptive statistics (means and standard deviations; frequencies and percentages) and non-parametric analyses (Wilcoxon Signed-Rank Tests).
RESULTS: Four qualitative themes emerged: (1) Psychosocial needs—participants expressed a need for emotional support in response to a lack of family connection and history of abusive relationships; (2) Effects of the transition process—understanding the unique aspects of gender-affirming surgery and symptoms related to hormone intake was important to participants; (3) A desire to serve others—participants wanted to volunteer in service of other LGBTQIA+ individuals with similar life experiences; and (4) Potentiality of independent living interventions—participants expressed a need for support to locate housing, improve financial management skills, and procure secondary education and work. Participants had a marginally significant increase in their satisfaction with (p = 0.09) and performance of (p = 0.06) life skills from the beginning to the end of the program. Participants demonstrated a marginally significant increase in goal ratings (p = 0.11) over the course of the program.
CONCLUSION: This researcher found that client-centered programming potentially helped trans and NB adults experiencing homelessness acquire greater satisfaction performing meaningful occupations and making progress towards their independent living goals; however, more research is needed. There is a vital need to support trans and NB adults in gaining emotional support and independent living skills to close disparity gaps. OT practitioners can aid in developing occupation-based programming for the LGBTQIA+ community.
Hild, L., Simpson, E., & McDermott, C. (2019). Occupational needs of transitionally housed lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people. American Journal of Occupational Therapy, 73(4), 7311505164. https://doi.org/10.5014/ajot.2019.73S1-PO6013
Rhoades, H., Rusow, J. A., Bond, D., Lanteigne, A., Fulginiti, A., & Goldbach, J. T. (2018). Homelessness, mental health and suicidiality among LGBTQ youth accessing crisis services. Child Psychiatry & Human Development, 49, 643–651. https://doi.org/10.1007/s10578-018-0780-1
Romero, A. P., Goldberg, S. K., & Vasquez, L. A. (2020). LGBT people and housing affordability, discrimination, and homelessness. UCLA: The Williams Institute. https://escholarship.org/content/qt3cb5b8zj/qt3cb5b8zj.pdf
Wilson, B. D., Choi, S. K., Harper, G. W., Lightfoot, M., Russell, S., & Meyer, I. H. (2020). Homelessness among LGBT adults in the US. UCLA: The Williams Institute. https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Homelessness-May-2020.pdf