Occupational Therapy Outreach

Returning a sense of ownership to residents of community housing.

OT Outreach

In 2014, the Occupational Therapy Practice Framework-3 (OTPF-3) expanded the definition of “client” to include communities.1 Unfortunately, very little research has been done within the United States to illustrate the possibilities of occupational therapy within a community.

As part of a graduate project, we were offered the opportunity to build a self-sustaining resident association in a local housing community named Fairview in Eastern Tennessee.

With no knowledge of the community or what resident associations really were, we did some research. Resident associations give a united voice to community members and foster simple communication between the community and the housing authority.

Resident associations also provide a basis for community organizations, groups, educational classes, and informational meetings, and a place for people to express ideas or complaints.

A 2012 study found that individuals in public housing often develop a sense of learned helplessness exhibited through the feeling that they cannot elicit change in their community.2

Similarly, many community members do not feel a sense of ownership, as the lines between the housing authority and community members are blurred.

Therefore, the need for a healthy and functioning resident association is imperative in bridging the gap. Resident associations give people a voice, which helps provide a sense of ownership in the community.

From the Ground Up

Stephanie Fouts (center) and Heather Harvey (right) launched a resident association at a local housing community in Tennessee. Brenda (left) is gradually taking over responsibilities. (Photo courtesy Stephanie Fouts)
Stephanie Fouts (center) and Heather Harvey (right) launched a resident association at a local housing community in Tennessee. Brenda (left) is gradually taking over responsibilities. (Photo courtesy Stephanie Fouts)

Once we had an understanding of what resident associations were, we did not know where to begin. Leclair (2010) suggests that occupational therapists may need to take on varying roles when trying to elicit change within a community, sometimes acting as a leader, and other times as a facilitator.3

Since we were not members of the community, and wanted to create something sustainable, we decided to start some programs as a way to meet people. As we began making connections, we hoped we would find people interested in making lasting changes within the community.

These residents would then participate and could begin to help us, and then we would slowly transition responsibilities over to them. Eventually, we wanted to let them lead the community activities on their own.

To ensure that activities would be of interest to community members, we walked around the community, knocked on doors, and spoke with residents. This gave us an opportunity to find out about interests in potential activities and let us introduce ourselves.

We brought some suggestions with us and got a few ideas, such as Bingo, from some of the people. We initially got a lot of positive feedback, especially about kids’ programs.

We found a handful of people interested in helping. They made suggestions as to what we could do, so we were hopeful of community interest.

One woman had been a member of the resident association before it dissolved due to lack of membership; a minimum of three members is required, with five spots total offered.

She told us, “People around here just aren’t interested. I’d been a member for a long time, and I just don’t care to do it anymore.” She added that they used to have good turnouts for Bingo, but that was about it.

Stephanie Fouts (center) and Heather Harvey (right) launched a resident association at a local housing community in Tennessee. Brenda (left) is gradually taking over responsibilities. (Photo courtesy Stephanie Fouts)

Getting the Word Out

Since we were starting in the middle of the school year, we decided that homework help offered once per week would be our best option. To advertise, we hung fliers on doors throughout the neighborhood and spoke with community members. We hoped that by working with kids, we might connect with a few parents.

On the first day, armed with snacks, we arrived with enthusiasm to get started, but not sure what to expect. We consistently got a small group of children who came, some weekly, and others sporadically.

By the end of the program we had tutored 10 children. Unfortunately, though homework help was rewarding for us, we did not meet as many parents as we had hoped, and thus were not making the connections needed to jump-start the resident association.

Over the summer we were able to offer more diverse programs. To appeal to more adults, twice a month we offered a recipe sharing class for meals that would feed a family of four for under $10.

Unfortunately, it was not a success. We later learned that there had been confusion over the wording of the flier, and that people thought they’d have to spend $10 to come. After that, we made sure our communication was clear.

We also offered Bingo twice a month, and had more success in getting adults to come. The only downfall was that none were really interested in becoming active members in the resident association. We tried a different approach by starting a kids’ program that involved water games, crafts, and other activities that met twice per month.

We had a great turnout with 12 kids, which led to us meeting four adults. Two had been referred by the head of the housing authority because they were interested in restarting the resident association. The third was a mother, and the fourth had seen us playing outside and came to see what was going on.

Two of the women, Darlene and Brenda, became consistent helpers and had great ideas about programs the community needed, including karaoke night and girls’ night at the center.

The head of the housing association and I remained in contact throughout the project, and she gave Darlene and Brenda a key to the center as they slowly began taking on leadership roles. They both open the center for and help staff a youth Bible study that a local pastor puts on. Darlene helps pass out information and meals to families receiving food support.

We met with Darlene and Brenda to discuss the bylaws and responsibilities of the resident association members. To have them take over fully, we tasked them with finding another member to reach the minimum we needed to get the association going.

We would try to check in once per week to discuss potential member options and see how they were enjoying their responsibilities.

Occasionally they would report a behavioral problem among the children, and we would offer suggestions while leaving the power in their hands. Unfortunately, they have yet to find a third member, though they have found some people interested.

What We Learned

While we were unable to see the resident association fully started, we are confident that Darlene and Brenda will continue serving and eventually find another dedicated member or two to begin the resident association in Fairview again. We learned a great deal from this experience, particularly in the challenges we faced.

When examining the lack of participation through the Model of Human Occupation, issues with all three factors — volition (motivation), habituation (habits and roles), and performance capacity (physical and mental health) — were evident. Some were up-front and told us they would like to go, but had performance capacity issues, such as chronic pain, or just hadn’t felt up to much since their spouse passed. Others politely or bluntly expressed disinterest, a clear lack of volition.

However, some seemed genuinely interested, but did not follow through, which was likely in part a combination of all components. The environment being a public housing community, which often results in a lack of ownership, can influence volition, particularly in becoming interested in the resident association.

All of these factors not only influenced the attendance of our events, but the individuals’ lives in much deeper ways. Many had difficulty finding or maintaining work, and had recurring health issues.

Occupational therapy has so many tools to help improve quality of life. A community setting provides insight into how the environment affects volition, and in turn how a person’s individual components affect their environment. Similarly, working within the community allowed us to interact with a lot of people.

We saw opportunities to naturally insert general screenings into our interactions, which could help identify people who may typically slip through the cracks.

Working in a community setting inherently offers easy access to services that could greatly improve quality of life.