An Occupational View of LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, and other) Individuals Experiencing Homelessness; A Comparative Case Study

PURPOSE: Lesbian, Gay, Bisexual, Transgender, Queer, other individuals experiencing homelessness (LGBTQ+ IEH) are a population with no published studies exploring barriers to participation in meaningful occupations. Thus, the aim of this study was to explore the occupations of LGBTQ+ IEH & determine barriers preventing engagement.

DESIGN: A comparative case study qualitative methodology of two LGBTQ+ IEH was used. Purposeful sampling was used to recruit participants by referrals of the OTR at the homeless service agency (HSA). Inclusion criteria included individuals 18-75 years old, experiencing homelessness, identifying as LGBTQ+, & seeking services at the HSA.

METHOD: Qualitative interviews were conducted with participants regarding how their LGBTQ+ IEH identity impacts their occupational engagement. Participants completed the Activity Card Sort-Advancing Inclusive Participation (ACS-AIP) to determine current & desired occupational participation. Interviews were coded using qualitative content analysis and critical ideology was paired with queer theory to bring values of the researcher’s own LGBTQ+ identity into the reason & understanding of the research.

RESULTS: Participants reported the following barriers to participation in desired occupations: discrimination against identities, safety concerns, & increased time spent in resource seeking occupations. Both participants reported wanting to engage less in substance seeking, but reported using substances to cope with experiencing homelessness. Comparatively, time spent homeless appears to impact the amount of discrimination felt by the LGBTQ+IEH participants.

CONCLUSION: Lived experiences of LGBTQ+ IEH demonstrate barriers to participation in desired occupations including focusing on occupations of survival, discrimination of LGBTQ+ identities, & safety concerns. OTPs can have a role in addressing barriers & facilitators to participation as well as personal & environmental factors associated with LGBTQ+ IEH.

References

Ecker, J., Aubry, T., & Sylvestre, J. (2019) A review of the literature on LGBTQ adults who experience homelessness. Journal of Homosexuality, 66(3), 297–323. https://doi.org/10.1080/00918369.2017.1413277

Fraser, B., Chisholm, E., & Pierse, N. (2021). ‘You’re so powerless’: Takatāpui/LGBTIQ+ people’s experiences before becoming homeless in Aotearoa New Zealand. PloS one, 16(12), e0259799. https://doi.org/10.1371/journal.pone.0259799

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Tyminski, Q. P., Drummond, R. R., Heisey, C. F., Evans, S. K., Hendrix, A., Jaegers, L. A., & Baum, C. M. (2020). Initial development of the Activity Card Sort-Advancing Inclusive Participation from a homeless population perspective. Occupational Therapy International, 2020.