Innovative Intervention

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April 2002

By Lauren Hirigoyen

Georgiana Herzberg, PhD, OTR/L, (sitting second from left) and Tina Weekley, MOT, (standing) lead a session titled "What Does it Take to Add More Success to Your Life?" where participants learn to juggle scarves as a way of illustrating the importance of focusing on what they want to do, learning skills in manageable sequences, being patient with themselves, and persisting in their goals.

OT students help homeless people recover the skills they need to return to mainstream society.

Most graduate education programs incorporate hands-on application of skills in the classroom. However, Nova Southeastern University (NSU) in Fort Lauderdale, Fla, has taken this concept to the next level by joining forces with the Salvation Army of Broward County, Florida. Students enrolled in audiology, occupational therapy, optometry, and dispute-resolution programs have the opportunity to gain experience working with clients while assisting the community's underserved population.

The partnership is the brainchild of Georgiana Herzberg, PhD, OTR/L, associate professor in NSU's occupational therapy program. When Herzberg came to NSU in 1998, she began looking for a way to give back to the community. While attending a community meeting, Herzberg met Harold Dom, MSW, the director of social services for the Salvation Army, who wanted to improve and expand the programs offered at the time. Herzberg notes, "They were providing two hots and a cot-dinner, breakfast, and a place to sleep-but that was not helping people build skills."

The Ball Gets Rolling
Several months later, NSU recruited Marcia Finlayson, PhD, OT(C), OTR/L, who is now an assistant professor in the Department of Occupational Therapy at the University of Illinois at Chicago.

She attended one of the Health Resources and Services Administration (HRSA) workshops for people who want to apply for funding. She and Herzberg then teamed up to prepare a proposal for a training program for university students to work at the Salvation Army homeless shelter. Herzberg says, "We have complementary skills. I am a really hands-on person, and she was interested in the grant aspect. So I became the project director, and she became the project evaluator."

They submitted the grant, and HRSA accepted the proposal to fund the project. Herzberg asserts, "The federal government really is interested in providing services that are culturally sensitive and empowering to the people who are supposed to be served."

Through this program, Herzberg says, "students have the opportunity to participate in real world experiences and to see that they make a difference. It helps them confront their stereotypes, making them more sensitive and caring health care providers." Additionally, students learn about applied research to monitor process and outcomes.

Logistics
The Salvation Army's main shelter has two parts-an emergency shelter and transitional housing. People are allowed to stay in the emergency shelter for a few days, but can remain in the transitional area for up to 9 months if employed. NSU's students focus primarily on the transitional housing residents since they are there for a longer period of time. People who are staying at the shelter check in anytime after 5:00 pm and have dinner shortly thereafter. Any programming that is offered to the residents must occur between dinner and "lights out" at 10:00 pm.

Herzberg says, "All of the residents are there because they want to make a change in their lives, and you have to be clean of drugs and sober to be there." She notes that substance abuse has been a problem for many of the residents, and they often struggle with low self-esteem. According to Herzberg, preliminary research indicates that "as many as 30% of the population studied have said they have had a ‘severe head injury.'" She says that traumatic brain injury (TBI) occurs in 1% of the general population, and "people with TBI need alternative methods for teaching and learning."

The project focuses on enabling the shelter residents to become more effective members of the work force. Herzberg says, "It is easier to be productive if you have the underpinnings in place-if you can see what is going on, you can hear what is going on, you can get along with people-which is why we got the other disciplines involved."

The grant began in July 2000 and will fund the program for 3 years. One of the team's main goals is to ensure that the project is sustainable. Finlayson emphasizes that their current focus is on building infrastructure. "It is a matter of tying what we're doing into the existing curriculum and the different programs. As a result, when we no longer have the federal funding, it will [continue to] happen," she says.

Student Dedication
Since the program's inception, 148 students have registered and participated. Occupational therapy and optometry are the disciplines with the highest involvement-each with 40%. The majority of the students are in the second year of their professional program.

The project has drawn significant attention thus far. "As a result of this interaction, we have had seven peer-reviewed articles and 14 presentations at state and national venues, and I had a paper accepted for the World Federation of Occupational Therapy meeting, which will be held in Stockholm on June 23-28," Herzberg says, noting that 23 different students have been involved in these projects.

Tina Weekley, MOT, a December 2001 graduate of NSU, was involved in the program and believes that participating students gain a better understanding of the mental health arena and the diversity of disorders. She led groups dealing with activities of daily living like time and money management, self-esteem, attitude adjustment, basic hygiene, and even preventive health care. Weekley says, "We have them build on their existing strengths and then help them develop new ones."

Herzberg leads the group when she first takes students to the shelter so they have a role model, and also conducts a communication exercise. Then the group works together to process the skills learned from each activity. Finlayson says that students tend to stay for about 2 hours each time they go.

Communication Is The Key
The program works with communication as a central theme. According to Herzberg, residents "need an opportunity to practice what are essentially prevocational skills." They must manage work quantity and quality, focus on the task at hand, and follow through from start to finish. Weekley says that the residents are used to functioning alone on the streets, and they need to learn how to live and work with others in a community. The OTs prepare residents for what they will encounter in a work environment through discussion and role-playing exercises.

The program schedules shift and change depending on who participates. Finlayson says, "It has to be client-centered for it to work. The clients and the staff need to see that you are responding to their issues and concerns, because as soon as we start setting the agenda, saying that we are the experts, then it is not going to work."

Students receive mixed reactions from residents. "Often people would walk by, and we would invite them to join us. They would say no, but before you knew it, they would sit down and join the group," Weekley recalls. Others refused service altogether, insisting that help was not necessary.

Weekley had never been in contact with a homeless person prior to the experience, and she was uneasy about the project at first. "The students were apprehensive about going into a nontraditional site. There is no structure or protocol to follow. You have to be creative and come up with your own interventions," she says. Although it was initially unsettling, Weekley relaxed after her first visit to the shelter and says that Herzberg and Tina Gelpi, MEd, OTR/L, the staff occupational therapist who worked with the Salvation Army, set a good example by keeping an open mind and not making judgments.

During a group session in which one of the residents was overly talkative and becoming a distraction, Weekley applied strategies she had learned at school in order to set boundaries, define expectations, and direct the group's focus back to the topic of discussion. She expects to incorporate the group dynamics and activities she practiced at the shelter into the therapy she provides in the future

End Results
Weekley feels that the program was truly educational. She learned that individuals react differently to any type of intervention and would alter the activities to make them more personal for each member of the group. Residents with special needs also demanded individual treatment.

Herzberg is pleased with the project's progress thus far. Her students keep a journal when they go to the shelter. They email their entries to her, and she responds to them individually. "They look at things differently. The program increases their comfort level with people who are different from them. It provides them with practical experience that is supervised and mentored. It reinforces the importance of being engaged in the community and empowering people to use their strengths and focus on health, wellness, and improved occupational performance rather than simply on illness remediation," Herzberg says.

Herzberg has directed this venture with a larger goal in mind. Beyond this program, Herzberg hopes to influence the broader community. She explains, "When we think about providing services, we need to see the big picture. We need to think of interventions at different kinds of levels that help people with occupational performance. We need to look at the strengths and needs and potential contributions of all stakeholders-including those who are typically the recipients of direct services and those who are not. It is a mind-set-a lens from which you see things."

Lauren Hirigoyen is a contributing writer for Rehab Management.

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April 2002